Microsurgery in the Netherlands, from an experimental pharmacological perspective

This paper is dedicated to the memory of Hans Rensema (1948–2020), medical artist of Microsurgical Developments Foundation.The history of training in microsurgical and experimental techniques in the Netherlands goes back to the 1960s. The training was mostly done on an individual basis. Clinical surgeons could benefit from the 'Wet-Lab' training at the Erasmus University of Rotterdam. Experimental microsurgery and techniques training for larger groups of bio-technicians and researchers started at Utrecht University in 1993, and later at Groningen University. The first commercial training was offered at the International Microsurgical Training Centre in Lelystad (IMTC,) in 2002. This paper presents the current state-of-the-art training in the Netherlands and some future perspectives.Professor Remie studied Pharmacy at the University of Groningen. After completing his studies in 1983, he specialised in pharmacology and did his PhD on the presynaptic modulation of noradrenergic neurotransmission in the freely moving rat portal vein. He joined Solvay Pharmaceuticals as a Group leader in Pharmacology, specialized (1991) in Laboratory Animal Science (Utrecht University), and became Laboratory Animal Scientist and Animal Welfare Officer of Solvay Pharmaceuticals and Fort Dodge Animal Health Holland. He is chairman of the Microsurgical Developments Foundation and several IACUCs. From 1997 until 2012, he was appointed professor with a special chair in Microsurgery and Experimental Technique in Laboratory Animals at the Groningen Centre for Drug Research, Department of Biomonitoring & Sensoring, University Centre for Pharmacy, University of Groningen. He is CEO of 3-R's Training Centre BV, and Director of the René Remie Surgical Skills Centre (www.rrssc.eu).Irene Cuesta Cobo earned a BSc in Biology and physiotherapy, and an MSc in manual therapy at the University of Jaén (Spain). She worked at the department of physiology at the same university on an in-vivo assay with gliomas in rats and subsequently, at the Laboratory of CAR Madrid to analyse top athletes' blood samples. She is a senior instructor at RRSSC.Edwin Spoelstra earned an MSc in Pharmacy and specialised stereotaxic surgery and microdialysis in the rat. He developed several techniques in mice and spent the last ten years on catheter design and blood-sampling.

Education of microsurgical technique for young surgeons by International Society for Experimental Microsurgery West Japan and future prospects

The need for microscopic vascular anastomosis has increased in the field of gastrointestinal surgery. Herein we report the activities for microsurgical training by ISEM West Japan.Since 2015, we have held the Hands-on seminar twice a year using artificial blood vessel. The participants sutured it with 9-0 polypropylene suture under bench microscopes. Competitions for microsurgical arterial anastomosis were held in the seminar, in which we evaluated the anastomosis regarding the leakage and patency.Totally 208 participants attended the hands-on seminar. No relation was seen between the years of surgical experience and the score. However, there was a relation between the number of participation and the score.Through our hands-on seminar, young surgeon could improve technique and motivation for the microsurgery.

Considerations about the experience in experimental microsurgery in Catania University

In the 1980s and 1990s Microsurgery has had a great diffusion in Italy. Our group, who worked in University of Catania, Sicily, got in touch with Sun Lee, the father of Experimental Microsurgery, and applied actively the microsurgical techniques both in the experimental and clinical field.Several Courses have been organized in Catania to involve young doctors who have been charmed by this new surgical branch.It is our opinion that in the present time Microsurgery could play an important role in the training of the general surgery residents. An experimental microsurgical training, together with simulators, could guarantee a more complete training of the residents, helping them to be familiar with surgical instruments and suture materials, improving their skill in performing microvascular anastomoses (carotid and femoral arteries) and more complex surgical operations (portocaval shunt) and leading them to a valid research activity.

Complications after sciatic nerve defect repair in rats

Experimental microsurgery is a provocative field with great rewards. Nerve microsurgery is particularly challenging because the results of the operation can only be tardily observed. During this time frame, multiple complications can appear to the laboratory rats, which can influence the final results. For this reason, when experimenting with Wistar rats, one must be familiarized with the possible complications in order to know the suitable solutions for all the issues. Lack of information and henceforth lack of action might result in compromising the final data.

Liver bud transplantation in rats

Introduction: Research has made progress in organ fabrication using an extracellular matrix, cell sheets, or organoids. Human liver tissue has been constructed using a 3-dimensional (3D) bioprinter and showed evidence that an in vitro generated liver bud was reformed in a rodent liver model. This study describes the stages of development of rat fetal organs and liver structure and reviews recent progress in liver organoid transplantation. Methods: The authors developed the procedures for creating a transected plane for use in experimental microsurgery in rats. A liver lobe was fixed vertically with gauze and it was ligated with 6-0 silk suture in the cut line; the parenchyma was cut, and major vessels were ligated to create the transected plane. The ligated tissue was carefully resected. Hemostasis was not required and hepatic components remained on the transected plane. The plane was covered by omentum. Results: Using this model, we transplanted fetal liver or a 3D bioprinted liver organoid. This microsurgical method enabled creation of an intact liver parenchyma plane. No bleeding was observed. The transplanted liver components successfully engrafted on the liver. Conclusion: This method may provide an essential environment for growing liver using portal and arterial blood flow.

Defining Standards in Experimental Microsurgical Training: Recommendations of the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM)

Background: Expectations towards surgeons in modern surgical practice are extremely high with minimal complication rates and maximal patient safety as paramount objectives. Both of these aims are highly dependent on individual technical skills that require sustained, focused, and efficient training outside the clinical environment. At the same time, there is an increasing moral and ethical pressure to reduce the use of animals in research and training, which has fundamentally changed the practice of microsurgical training and research. Various animal models were introduced and widely used during the mid-20th century, the pioneering era of experimental microsurgery. Since then, high numbers of ex vivo training concepts and quality control measures have been proposed, all aiming to reduce the number of animals without compromising quality and outcome of training. Summary: Numerous microsurgical training courses are available worldwide, but there is no general agreement concerning the standardization of microsurgical training. The major aim of this literature review and recommendation is to give an overview of various aspects of microsurgical training. We introduce here the findings of a previous survey-based analysis of microsurgical courses within our network. Basic principles behind microsurgical training (3Rs, good laboratory practice, 3Cs), considerations around various microsurgical training models, as well as several skill assessment tools are discussed. Recommendations are formulated following intense discussions within the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM), based on scientific literature as well as on several decades of experience in the field of experimental (micro)surgery and preclinical research, represented by the contributing authors. Key Messages: Although ex vivo models are crucial for the replacement and reduction of live animal use, living animals are still indispensable at every level of training which aims at more than just a basic introduction to microsurgical techniques. Modern, competency-based microsurgical training is multi-level, implementing different objective assessment tools as outcome measures. A clear consensus on fundamental principles of microsurgical training and more active international collaboration for the sake of standardization are urgently needed.