J Reconstr Microsurg 2019; 35(01): 015-021
DOI: 10.1055/s-0038-1657791
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Developing a Three-Layered Synthetic Microsurgical Simulation Vessel

Lilli Cooper
1   Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Katia Sindali
1   Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Karthik Srinivasan
2   Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
,
Martin Jones
1   Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Nora Nugent
1   Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
› Author Affiliations
Further Information

Publication History

24 October 2017

12 April 2018

Publication Date:
11 July 2018 (online)

Abstract

Background Microsurgery is increasingly relevant, and is difficult to learn. Simulation is relied upon ever more in microvascular training. While living models provide the ultimate physiological feedback, we are ethically obliged to optimize non-living models to replace, refine, and reduce the use of animals in training. There is currently no three-layered synthetic vessel available for microsurgical training.

Methods A three-layered synthetic vessel was designed with a simulation company. One anastomosis was performed by 14 microsurgical experts at one center. The realism of the vessel was assessed via user questionnaires and the construct validity using objective, validated task scores to assess the anastomosis performance and the final product. Videos were obtained, which were anonymized and marked remotely by a consultant plastic surgeon.

Results The synthetic vessel intima and media displayed reasonable realism, while the adventitia was less realistic. Areas for improvement were identified. Both the task specific assessment score and the final product assessment appropriately identified experts.

Conclusion A three-layered synthetic model for microvascular training is a hygienic and useful intermediate-level alternative to commonly used synthetic and ex vivo alternatives.

Note

This work was presented at the Doctors' Updates, Val d'Isere, on February 2, 2017.


 
  • References

  • 1 Nimmons GL, Chang KE, Funk GF, Shonka DC, Pagedar NA. Validation of a task-specific scoring system for a microvascular surgery simulation model. Laryngoscope 2012; 122 (10) 2164-2168
  • 2 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63 (08) 1329-1334
  • 3 Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training. J Reconstr Microsurg 2016; 32 (03) 233-241
  • 4 Singh M, Ziolkowski N, Ramachandran S, Myers SR, Ghanem AM. Development of a five-day basic microsurgery simulation training course: a cost analysis. Arch Plast Surg 2014; 41 (03) 213-217
  • 5 Theman TA, Labow BI. Is there bias against simulation in microsurgery training?. J Reconstr Microsurg 2016; 32 (07) 540-545
  • 6 Korndorffer Jr JR, Kasten SJ, Downing SM. A call for the utilization of consensus standards in the surgical education literature. Am J Surg 2010; 199 (01) 99-104
  • 7 Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993; 100 (03) 363-406
  • 8 Nicholas RS, Madada-Nyakauru RN, Irri RA, Myers SR, Ghanem AM. Research priorities in light of current trends in microsurgical training: revalidation, simulation, cross-training, and standardisation. Arch Plast Surg 2014; 41 (03) 218-224
  • 9 The Animals (Scientific Procedures) Act, 1986. Her Majesty's Stationery Office. Available at: www.legislation.gov.uk/ukpga/1986/14/pdfs/ukpga_19860014_en.pdf
  • 10 www.Gov.uk . Research and testing using animals. Available at: https://www.gov.uk/guidance/research-and-testing-using-animals2016 . Accessed February 2017
  • 11 Onoda S, Kimata Y, Sugiyama N. , et al. Analysis of 10-year training results of medical students using the microvascular research center training program. J Reconstr Microsurg 2016; 32 (05) 336-341
  • 12 Willis RE, Wiersch J, Adams AJ, Al Fayyadh MJ, Weber RA, Wang HT. Development and evaluation of a simulation model for microvascular anastomosis training. J Reconstr Microsurg 2017; 33 (07) 493-501
  • 13 Evgeniou E, Tsironi M, Riley D. Improving fellowship training in microsurgery: a threshold concepts perspective on the curricula of fellowship programs. J Reconstr Microsurg 2015; 31 (08) 579-589
  • 14 Trignano E, Fallico N, Zingone G, Dessy LA, Campus GV. Microsurgical training with the three-step approach. J Reconstr Microsurg 2017; 33 (02) 87-91
  • 15 Alessi SM. Fidelity in the design of instructional simulations. J Comput-Based Instr 1988; 15 (02) 40-47
  • 16 Usón J, Calles MC. Design of a new suture practice card for microsurgical training. Microsurgery 2002; 22 (08) 324-328
  • 17 Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering fidelity in simulation-based training. Acad Med 2014; 89 (03) 387-392
  • 18 Grober ED, Hamstra SJ, Wanzel KR. , et al. The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg 2004; 240 (02) 374-381
  • 19 Stone JP, Doherty CC, Schrag CH. Incidence and type of errors in microsurgical technique in surgical trainees. J Reconstr Microsurg 2016; 32 (07) 528-532
  • 20 Kim E, Singh M, Akelina Y, Shurey S, Myers SR, Ghanem AM. Effect of microvascular anastomosis technique on end product outcome in simulated training: a prospective blinded randomized controlled trial. J Reconstr Microsurg 2016; 32 (07) 556-561