O que os olhos não veem a microcirurgia ensina: modelo de treinamento oftalmológico com olho de boi / What the eye cannot see, microsurgery teaches: a model of ophthalmological training with a bull's eye

RESUMO Objetivo Descrever e validar um modelo oftalmológico para treinamento de transplante e microssutura de córnea utilizando globo ocular bovino. Métodos Para a montagem do modelo de treinamento, o globo ocular foi disposto sob o campo cirúrgico, apoiado sobre um recipiente plástico cilíndrico comum de 3,5cm de diâmetro, para a retirada da córnea. Foi realizada uma incisão circular superficial, e, posteriormente, uma tesoura Castroviejo curva de 9 cm foi utilizada para remoção completa da córnea, que foi recolocada em sua posição original, para que, em seguida, fossem confeccionados nove pontos equidistantes, usando fio de nylon 10-0. Por fim, foram avaliados os seguintes critérios: tempo de realização das suturas; evolução do tempo e da qualidade a cada teste; e destreza e aperfeiçoamento da realização das suturas. Resultados O modelo descrito demonstrou-se viável e adequado para o treinamento de microssuturas na córnea, possibilitando aperfeiçoamento e ganho de habilidades cirúrgicas. Conclusão O modelo de treinamento microcirúrgico apresentado possui alta viabilidade para a simulação de cirurgias oftalmológicas e textura semelhante à do olho humano real, o que o torna próximo à realidade.

ABSTRACT Objective To describe and validate an ophthalmic model for corneal transplantation and micro suture training using a bovine eyeball as a model. Methods For the training model, the eyeball was placed under the sanitary field placed on the ends of a common 3.5cm diameter cylindrical plastic container for corneal removal. A superficial circular incision was made, then 9cm curved Castroviejo scissors were used for complete corneal removal. The cornea was replaced in its original position, and 10-0 nylon thread was used to perform the sutures, with 9 equidistant stitches. Finally, the following criteria were evaluated: suturing time, time and quality progression in each attempt, dexterity and suturing improvement. Results The described model proved to be feasible and suitable for corneal micro suture training, allowing improvement and gain of dexterity in the sport. Conclusion The presented microsurgical training model has a high feasibility for the simulation of ophthalmic surgeries, in addition to a texture similar to the real human eye, which makes it close to reality.

What came first: the egg or the microsurgery training? An ophthalmic model for developing basic skills in microsurgery / O que veio primeiro: o ovo ou o treinamento microcirúrgico? Um modelo oftalmológico para desenvolver habilidades básicas em microcirurgia

ABSTRACT Purpose: To describe a new accessible model of ophthalmological training using chicken eggs. Methods: With the aid of a spherical drill, the external calcified layer and the cuticle of the chicken eggshell were removed in a 2cm diameter circle. Using a video-magnification system, the film was dissected and cut to approximately 1.5 cm diameters. The film was removed and repositioned to make interrupted 12-0 nylon microsutures. The parameters analyzed were: cost, facility of acquisition and handling, time for making the model and the microsutures and number of possible uses. Results: In all simulators, it was possible to carry out separated and equidistant micro-sutures in the egg membrane, without the need for reintervention. Conclusion: The new chicken-egg model for ophthalmic surgery training is low-cost, easy to acquire and handle, and viable for the development of basic microsurgery skills.

RESUMO Objetivo: Descrever um novo modelo acessível de treinamento oftalmológico com ovo de galinha. Métodos: Com o auxílio de uma broca esférica, a camada calcificada externa e a cutícula da casca do ovo de galinha foram retiradas em um círculo 2 cm de diâmetro. Mediante um sistema de videomagnificação, a película foi dissecada e cortada em formato aproximado de 1,5 cm de diâmetro. A película foi removida e reposicionada para a confecção de microssuturas interrompidas com nylon 12-0. Os parâmetros analisados foram: custo, facilidade de aquisição e manuseio, tempo para confecção do modelo e para a confecção das microssuturas e número de utilizações possíveis. Resultados: Em todos os simuladores foi possível realizar microssuturas separadas e equidistantes na membrana do ovo, sem necessidade de reintervenção. Conclusão: O novo modelo com ovo de galinha para o treinamento de cirurgia oftalmológica é de baixo custo, fácil aquisição e manuseio, além de ser viável no desenvolvimento de habilidades básicas em microcirurgia.

Estudio comparativo de laringes humanas y de cerdos: hacia un modelo de entrenamiento quirúrgico / Comparative study of human and pig larynxes: towards a surgical training model

Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.

Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.

Portable model for vasectomy reversal training

ABSTRACT Objectives To validate an experimental non-animal model for training of vasectomy reversal. Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Entrenamiento básico de microcirugía. Centro de Cirugía Experimental, Instituto de Ciencias Básicas y Preclínicas "Victoria de Girón" / Basic microsurgery training. Center for Experimental Surgery, "Victoria de Girón" Institute of Basic and Pre-Clinical Sciences

Introducción: Las técnicas microquirúrgicas son hoy enormemente aplicadas en el mundo en diferentes especialidades quirúrgicas. El centro, desde la década del 90, comenzó a impartir los entrenamientos de microcirugía vascular y nerviosa a especialistas y residentes nacionales y extranjeros respectivamente. Objetivo: Evaluar los resultados del entrenamiento de microcirugía que se imparte en el Centro de Cirugía Experimental de la Facultad de Medicina Victoria de Girón. Material y métodos: Se realizó un estudio longitudinal retrospectivo para evaluar el programa que se oferta. El entrenamiento está dividido en tres partes fundamentales: Parte teórica; prácticas en un simulador de látex; sutura termino-terminal de intestino delgado sobre la rata y, por último, el desarrollo de las técnicas básicas microquirúrgicas para un total de 90 horas. La matricula total en el período fue de 203 cursistas a quienes se les aplicó una encuesta al finalizar el entrenamiento; se midió además el tiempo de realización de la anastomosis y la permeabilidad vascular para calificarlos de Mal, Bien y Excelente al concluir. Resultados: En general fueron satisfactorios en 90 por ciento de los estudiantes sobre todo aquellos que poseen o estudian una especialidad quirúrgica, quienes presentaron mejores habilidades en un corto período que aquellos que no practicaban la cirugía reduciendo el tiempo de realización de las anastomosis y obteniendo una buena permeabilidad vascular. Conclusiones: El entrenamiento básico de microcirugía implementado constituye una útil herramienta para que los educandos desarrollen las habilidades necesarias para poder acometer con éxito las prácticas microquirúrgicas en la clínica quirúrgica(AU)

Introduction: Microsurgical techniques are currently applied in different surgical specialties worldwide. During the 90´s, our center began to implement vascular and nerve microsurgery trainings to specialists and national and foreign residents, respectively. Objective: To evaluate the results of microsurgery training that it is taught in the Center for Experimental Surgery at Victoria de Girón Institute of Basic and Pre-Clinical Sciences. Material and methods: A retrospective longitudinal study was carried out to evaluate the microsurgery training program. The training was divided into three main parts: theoretical lessons; practices upon the latex simulator; end-to-end anastomosis of small intestine on the rat; and finally, the development of basic microsurgical techniques on different vascular structures (abdominal aorta and vein) and the sciatic nerve of the rat, for a total of 90 hours of training. The total enrollment during the mentioned period was 203 students to whom a survey was applied at the end of the training; also, the time of realization of anastomosis and the vascular permeability were measured and evaluated as Bad, Good, and Excellent. Results: The results were satisfactory in general, but 90 percent of students that were carrying out their studies of a surgical specialty showed better skills in a shorter period than those that didn't practice surgery, demonstrating a less time-consuming exercise in the realization of vessel anastomosis and obtaining a good vascular permeability in this group. Conclusions: This teaching method constitutes a useful tool so that the students develop the necessary skills to carry out microsurgical practices in clinical surgery successfully(AU)

New trends in translational microsurgery

Abstract Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.

Experiences with basic microsurgical training programs and skill assessment methods at the University of Debrecen, Hungary

Abstract During the past decades microsurgical training programs together with skill assessment methods had been developing intensively worldwide. Concerning the teaching of basic techniques at various levels, we aimed to summarize the education program types and experiences at our department, in order to define the way of continuity. All in the hope that this summary might contain useful information for other educators as well. About 50 years ago, in the late 1960s, microsurgical basic education had been established in Debrecen. Since the 1990s multilevel education programs have been developed, starting in undergraduate years up to the postgraduate training, residency and continuous medical education programs. In the last three decades about 2,300 participants completed courses, including over 470 residents. The ones who already succeeded microsurgical course as medical students, during residency program could reach better results and skill development. Concluding thoughts, the traditional methods and special experiences are highly important in microsurgical education. The necessary duration and individual training approach are emphasized. Standardization (self and international), comparability, accessibility, providing milestones of microsurgical skills are key factors. Proper feedback and skill assessment (experiences, internationally recognized scores, or combinations) are indispensable, but have to be fitted to the characteristic elements of the course.

Modelo ex-vivo com coração bovino: proposta para treinamento de dissecção microscópica e de microanastomoses vasculares / Ex vivo model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses

RESUMO O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.

ABSTRACT Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons.

A non-living, effective model for microvascular training

Abstract Purpose: To introduce a nonliving microvascular training model based on vessels diameter and feasibility. Methods: We dissected ten oxen tongues, and divided the pedicles into three-thirds: proximal, middle and distal. We measured the external vessels diameter in all regions. We performed a descriptive statistical analysis. Three students (two beginner level and one intermediate level) performed this training. We evaluated the confidence, according Likert scale. Results: We dissected all oxen tongues, each tongue showed two parallel pedicles. Each pedicle was located at 1.5 - 2.0 cm from the midline. Proximal median artery and vein diameter were 3.9 ± 0.7, and 5.04 ± 1.44mm, respectively. In the middle third, the mean artery diameter was 3.3 ± 0.4mm, and the vein diameter was 3.5 ± 0.9mm. The distal third showed a mean artery diameter of 2.0 ± 0.42mm, and a vein diameter of 2.4 ± 0.82mm. The students performed ten anastomoses. This study showed a higher confidence level (CL) (p=0.03) than the pre training CL assessment. Conclusion: This study suggested a feasible non-animal model for microsurgical training process for beginners and intermediate trainees.

Translational microsurgery. A new platform for transplantation research

ABSTRACT PURPOSE: Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS: Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS: Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS: Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.

Microsurgical training model with nonliving swine head. Alternative for neurosurgical education

PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills. .

Learning surgical anatomy in the field of microsurgical reconstructive surgery: a new pedagogic method on human fresh cadavers / Aprendizaje de la anatomía quirúrgica en la cirugía microquirúrgica reconstructiva: un nuevo método pedagógico en cadáveres humanos frescos

Microsurgical vascular anastomosis in reconstructive surgery learning is usually based on rat dissection. But this technique does not allow dissection of the flap, preparing of the recipient vessels training, and suturing in conditions as realistic as possible of the surgery. The aim of this study was to describe a technique of surgical anatomy learning on human fresh cadavers, easy to perform and to evaluate its pedagogic interest. In the first part of the study, six fresh cadavers have been dissected simulating 6 forearm flaps with growing difficulty. In the second part of the study, 30 residents in surgery were evaluated on their ability to recognize main anatomic structures and to perform microsurgical anastomosis, of forearm flaps anastomosed on facial vessels. Concerning the first part of the study, it has been possible to use this method in all cases. The second part of the study showed that all the residents performed the dissection of the flap with success. The main anatomic structures (origin of the radial and ulnar arteries, companion veins of radial artery) have been identified by all the residents. The cephalic vein, the median antebrachial vein and the superficial branch of the radial nerve have been identified by most of the residents. The lateral antebrachial cutaneous nerve has been identified by only 12 residents. The arterial anastomosis has been performed with success in most cases (11/15 dissections), and the venous anastomosis in only 5/15 dissections. Surgical anatomy learning in the field of microvascular reconstructive surgery on human fresh cadavers is possible, easy to organize in a anatomy department. This method has to be considered as a useful complement of microvascular anastomosis learning on rats.

La anastomosis microquirúrgica vascular en el aprendizaje de cirugía reconstructiva generalmente se basa en la disección de la rata. Sin embargo, esta técnica no permite la disección del colgajo, la preparación de la formación de vasos receptores, y la sutura en condiciones similares a la cirugía. El objetivo de este estudio fue describir una técnica de enseñanza de la anatomía quirúrgica en cadáveres frescos, fáciles de realizar y con el objetivo de evaluar su interés pedagógico. Inicialmente en el estudio, seis cadáveres frescos fueron disecados simulando 6 colgajos de antebrazo con creciente dificultad. En la segunda parte del estudio, 30 residentes de cirugía fueron evaluados en su capacidad para reconocer las principales estructuras anatómicas y realizar anastomosis microquirúrgica de los colgajos del antebrazo anastomosados en vasos faciales. En la primera parte del estudio, fue posible usar este método en todos los casos. Durante la segunda parte del estudio todos los residentes realizaron la disección del colgajo con éxito. Las principales estructuras anatómicas (origen de las arterias radial y ulnar, venas acompañantes de la arteria radial) fueron identificadas por todos los residentes. La vena cefálica, la vena mediana del antebrazo y la rama superficial del nervio radial fueron identificados por la mayoría de los residentes. El nervio cutáneo antebraquial lateral fue identificado por 12 residentes. La anastomosis arterial fue realizada con éxito en la mayoría de los casos(11/15 disecciones), y la anastomosis venosa en sólo 5/15 disecciones. La docencia en anatomía quirúrgica y en el campo de la cirugía reconstructiva microvascular en cadáveres frescos es posible y fácil de organizar en un departamento de anatomía. Este método debe ser considerado como un complemento en la docencia de anastomosis microvascular en ratas.

An alternative experimental model for training in microsurgery / Modelo experimental alternativo para treinamento em microcirurgia

OBJECTIVE: to describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduate students of the Discipline of Operative Technique of the UFPR Medical School. METHODS: after the completion of splenectomy we performed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After complete dissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made the anastomosis of the vessels with 9.0 nylon. RESULT: the microsurgical training with a well-defined routine, qualified supervision and using low cost experimental materials proved to be effective in the practice of initial microvascular surgery. CONCLUSION: the use of pig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having the consistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the initial learning phase of this technique. .

OBJETIVO: descrever um novo modelo de treinamento em microcirurgia com baço de suínos após esplenectomia realizada pelos alunos de graduação da disciplina de técnica operatória do curso de medicina da UFPR. MÉTODOS: após a realização da esplenectomia realizamos dissecção do pedículo vascular distal e proximal a ligadura realizada para a retirada do baço. Após a dissecção completa da artéria e veia esplênica ,com microscópio, são colocados os clampes e o vaso é seccionado. É então realizada a anastomose dos vasos com mononylon 9,0. RESULTADO: o treinamento microcirúrgico, com uma rotina bem definida, supervisão qualificada e utilizando materiais experimentais de baixo custo, mostrou-se efetivo na prática de cirurgia microvascular inicial. CONCLUSÃO: a utilização do baço suíno, que seria desprezado após esplenectomia, é um excelente modelo para treinamento microcirúrgico, pois além de ter a consistência e delicadeza de um modelo real poupa o sacrifício de um novo modelo animal, na fase inicial de aprendizado desta técnica. .

An experimental model to retraining in microvascular suture

PURPOSE: To demonstrate an experimental model of up to four hours a week of independent study that allows relearning in microvascular sutures. METHODS: Wistar rats between 200 and 500 grams surplus research experiments were used. Femoral vessels are covered on one or both sides through a groin incision obliquely along the inguinal ligament. Femoral artery and vein are isolated and measured being clamped and cut. The individual performs in microvascular anastomosis complexity arterial and venous terminoterminal sequence. terminolateral and venous and arterial grafts in vessels. Permeability is evaluated by testing vascular patency after creation of microvascular anastomosis. RESULTS: In the first specimen, only arterial and venous vascular anastomosis are performed terminoterminal. The average diameter of the femoral veins varies from 0.8 to 2 mm between rodents (artery, between 0.6 and 1.4 mm, between 0.8 and 2 mm vein). The superficiality of the vessels allows faster dissection, may also be held in other inguinal region. CONCLUSION: The model of individual retraining allows learning microvascular suture in individuals of permanent staff. .

Entrenamiento microquirúrgico básico para realizar un modelo animal de alotrasplante compuesto vascularizado / Basic microsurgical training for a vascularized composite allotransplantation animal model

Introduction: rat hind limb transplantation is a complex animal model of vascularized composite allo-transplantation (VCA). A basic microsurgical training is required prior to the implementation of this model. Aim: to propose a training program for the acquisition of basic skills to perform a microsurgical VCA model. Animals and Methods: the training program was conducted in two stages. First, at the dry lab, basic suturing skills with 9-0 to 11-0 nylon sutures were practiced, reproduced from surgical videos performed by experts. In a second stage, at the wet lab using 13 Lewis rats, 6 hind limb microsurgical dissections were performed and the important steps for transplantation were identified: 10 end to end femoral artery anastomoses with 10-0 nylon interrupted suture; 10 end to end femoral vein anastomoses with 10-0 nylon suture; 3 femoral vein interposition in the femoral artery; 6 end to end sciatic nerve neurorrhaphy; 4 femur osteosynthesis with 21g needle and wire cerclage. Anastomotic patency rate and anastomotic surgical time were recorded. Results: arterial and venous patency rate was 100 and 90 percent respectively. Surgical time decreased from 49 to 24 minutes on arterial anastomoses and from 55 to 25 minutes on venous anastomoses after completion of the training program. When a vein interposition was performed, an immediate patency rate of 100 percent was obtained. Conclusion: a successful staged training model of basic microsurgical skills was performed, in order to perform a VCA model.

Introducción: el trasplante de extremidad posterior de la rata es un modelo microquirúrgico de alotras-plante compuesto vascularizado (ACV), que requiere para su implementación de un entrenamiento microquirúrgico básico sistematizado. Objetivo: comunicar un modelo de entrenamiento microquirúrgico básico para adquirir las habilidades y destrezas que permitan realizar un modelo microquirúrgico de ACV Animales y Métodos: el entrenamiento se realizó en 2 etapas: la primera, en laboratorio en seco. A partir de vídeos de microcirugía, se practicó las destrezas para maniobrar suturas de nylon de 9-0 a 11-0. En la segunda etapa in vivo con animales, (13 ratas Lewis), se realizaron: 6 disecciones microquirúrgicas de extremidad posterior para reconocimiento de estructuras anatómicas; 10 anastomosis término-terminal (T-T) de arteria femoral con sutura interrumpida 10-0; 10 anastomosis T-T de vena femoral; 3 interposiciones de vena femoral en arteria femoral; 6 neurorrafias T-T de nervio ciático; 4 fijaciones óseas de fémur con aguja 21 g y cerclaje con alambre. Se evaluó la permeabilidad de las anastomosis y los tiempos quirúrgicos. Resultados: anastomosis arteriales: la permeabilidad inmediata fue de un 100 por ciento. Los tiempos de anastomosis disminuyeron de 49 a 24 min con el entrenamiento. Anastomosis venosas: la permeabilidad inmediata fue de un 90 por ciento. Los tiempos de anastomosis disminuyeron paulatinamente de 55 a 25 min. Interposiciones venosas: se logró una permeabilidad de 100 por ciento. Conclusión: una estrategia de entrenamiento por etapas, es una forma factible de entrenamiento en microcirugía. Este entrenamiento permite obtener una aceptable permeabilidad anastomótica, paso crítico para realizar modelos de ACV.

Uso racional de modelos animais para pesquisa e ensino de microcirurgia / Rational use of animal models for research and microsurgery training

O objetivo deste estudo é divulgar um modelo experimental de baixo custo, que respeita as normas regulamentadoras das experiências com animais Utilizando animais mortos em outros experimentos contribuindo com a melhora do aprendizado de microcirurgia. São utilizados cadáveres de ratos da raça Wistar, oriundo de descarte de outros cursos. Os cadáveres dos ratos descongelados são utilizados para o treinamento básico de microcirurgia dos acadêmicos do curso de medicina da Universidade Nove de Julho, visando contribuir para o treinamento de acadêmicos, sua utilização se justifica pelo baixo custo do material empregado e muitos animais são poupados durante a fase intermediária do desenvolvimento de habilidades para realização das micro-anastomoses. Este modelo experimental é de baixo custo e permite a utilização racional de animais, corroborando com as normas éticas da pesquisa experimental e contribuindo com o ensino e treinamento da microcirurgia.

The objective of this study is to disclose an experimental model of low cost, which complies with the regulatory norms of animal experiments by using dead animals from other experiments, contributing to the improvement of microsurgery learning. Cadavers of Wistar rats, originated from disposal of other courses, are used. The corpses of thawed mice are used for basic microsurgical training of medical students at the Nove de Julho University, aiming to contribute to the students' training. Their use is justified by the low cost of the material used, many animals being spared during the intermediate phase of skill development for realization of micro-anastomoses. This experimental model is inexpensive and allows the rational use of animals, corroborating with the ethical standards of experimental research and contributing to the education and training of microsurgery.

Treinamento inicial em microcirurgia / Initial training in microsurgery

A técnica microcirúrgica que até a década de 80 do século passado se constituiu um procedimento de exceção, somente utilizada em casos extremos, devido aos avanços facilmente observados em diversas publicações atuais, tornou-se em muitos procedimentos a primeira opção cirúrgica, fazendo com quase que, de maneira obrigatória, todos os médicos que exerçam a especialidade de Cirurgia Plástica tenham que realizar treinamento na citada técnica operatória. O presente artigo se propõe a apresentar um modelo de fácil execução como treinamento básico em microcirurgia.

The microsurgical technique witch until the 1980’s was an exclusion procedure, only chosen in extreme cases, due to easily observed advances seen in innumerous current publications, has become in various procedures the first surgical option, practically compelling all doctors who practice in the field of Plastic Surgery to perform training in the referred technique. The current article presents an easy executed model of microsurgery basic training.

Basic microsurgery training: comments and proposal

Microsurgical techniques have been applied in many surgical specialties and have also a broad application in surgical research. It demands high technical skills and continued training. The microsurgical training is lengthy, very expensive and demands high commitment. The microsurgical skills should be first mastered in the lab and only then applied in the clinic. Here, we propose a model of a training course in microsurgery. We also suggest that surgical societies involved with microsurgery promote training courses on a regular basis.

Microcirurgia tornou-se uma técnica aplicável em uma série de especialidades cirúrgicas e em pesquisa experimental. Microcirurgia exige alta qualidade técnica e treinamento contínuo. No Brasil, existe grande carência de microcirurgiões devido aos custos envolvidos no treinamento e na escassez de serviços que ofereçam treinamento especializado. O treinamento em microcirurgia é longo, caro e exige alto grau de dedicação. O completo domínio das técnicas de microcirurgia deve ser obtido primeiro no laboratório antes de ser empregada na prática clínica. Nesse artigo, propõe-se um modelo de curso teórico-prático em microcirurgia. Também sugere-se que sociedades de especialidades cirúrgicas mais ligadas à microcirurgia fomentem a capacitação de profissionais em microcirurgia através da realização de cursos básicos em microcirurgia.