RESUMO
Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
Historique: Depuis que la première anastomose microvasculaire a été décrite, de nombreuses méthodes ont été utilisées en plus de la méthode classique. L'adhésif tissulaire a donné des résultats prometteurs dans des études antérieures et peut représenter une solution rapide et efficace qui devra faire l'objet de plus d'études avant d'être adoptée en clinique. Méthodologie: Les chercheurs ont mené une étude expérimentale aléatoire et comparative sur des artères fémorales de rat. Ils ont effectué une anastomose de bout en bout pour comparer deux techniques d'anastomose. Dans un groupe, une seule suture interrompue a été utilisée, et dans le second, une combinaison d'un moins grand nombre de sutures et d'adhésif tissulaire a été privilégiée. La durée de l'anastomose, la durée totale de l'intervention, la vélocité du débit sanguin avant, immédiatement après et 48 heures après l'intervention, de même que le classement indépendant de l'anastomose immédiatement après l'intervention. L'imagerie par résonance magnétique a permis d'évaluer le degré de sténose. Après l'euthanasie, les chercheurs ont effectué l'histologie et la microscopie électronique sur les vaisseaux pour évaluer les complications possibles. Résultats: Au total, 24 anastomoses ont été exécutées, soit 12 avec la technique classique et 12 avec la technique d'adhésion. Toutes les anastomoses étaient perméables et s'associaient à une réduction importante de la durée de l'anastomose et de l'opération totale. Le classement de l'anastomose a révélé de meilleurs résultats dans le groupe de suture classique. La vélocité du débit sanguin n'était pas statistiquement significative entre les deux groupes. On a constaté une anastomose sténosée à l'imagerie par résonance magnétique, tandis que l'histologie et la microscopie électronique ont révélé plus de complications dans le groupe d'adhésion. Conclusion: La durée de l'anastomose était beaucoup plus courte et présentait une tendance non significative vers un plus grand nombre de complications thrombotiques dans le groupe d'adhésion. Des améliorations des propriétés de la coller et le raffinement des techniques en feront probablement une solution viable pour remplacer les sutures.
RESUMO
BACKGROUND: Live animals have been used for decades as one of the many training models for developing surgical skills. Microsurgery in particular relies on training for skill acquisition and maintenance, using live animal models, especially rats (murine models). Efforts are underway to reduce the number of rats sacrificed to achieve this objective. METHODS: A group of students with minimal microsurgical experience, after having gone through a basic microsurgical course, were randomly split into three equal groups, all three groups following a 24-week standard training program based on low- and medium-fidelity training models with standardized murine training days. In addition to the standard training regimen, each participant performed supplementary training on live rats every 4, 6, or 8 weeks. According to the training program, the procedures have been performed on chicken legs, flower petals, and rats, each procedure being blindly assessed and evaluated using validated models and scales. The primary evaluated outcome was the Stanford Microsurgery and Resident Training (SMaRT) scale result of the final rat anastomosis performed by each group, for which the tested hypothesis was one of noninferiority. The secondary outcomes were represented by the final rat anastomosis time, final chicken leg anastomosis result and time, and the final petal score. RESULTS: After the 24th week, no differences were observed between the three groups regarding their microsurgical skills, as measured by the aforementioned surgical outcomes. All participants improved significantly during the study (mean [standard deviation] 19 ± 4 points on the SMaRT scale), with no significant differences between the groups, p < 0.001 for noninferiority. CONCLUSION: A training regimen based on low- and moderate-fidelity models, with the addition of training on a live rat every 8 weeks was noninferior to a training regimen that used a live rat every 6 weeks and also noninferior to a training regimen that used a live rat every 4 weeks.