Optimization of the non-living animal models for simulation-based microsurgical training.

[INTRODUCTION] Living animal models have been widely used for microsurgical training. Due to ethical concerns and animal care costs, non-living animal training models have gained significant popularity. The chicken thigh model has become a gold standard for preclinical microsurgical training. Efforts to optimize this model by using vessel perfusion have been previously reported. This study aims to further optimize the chicken thigh training model and to suggest a novel porcine rib model based on the implementation of the pulsatile perfusion technique.

[METHODS] Twenty optimized chicken thigh (OCTM) and twenty novel porcine rib (NPRM) training models were prepared. Model morphological parameters, preparation time, and cost were analyzed. A peristaltic pump was used for arterial perfusion, and the infusion bag was used for venous system perfusion. Training models were used for vessel dissection, microvascular anastomosis performance, and patency evaluation. Sixteen microsurgeons were invited to evaluate the surgical fidelity of both training models.

[RESULTS] Training model preparation time was 20.7 ± 1.9 min and 18.2 ± 1.5 min for the OCTM and the NPRM, respectively. The average artery and vein diameter (2.3 ± 0.2 mm and 2.9 ± 0.2 mm in OCTM; 1.7 ± 0.2 mm and 1.6 ± 0.2 mm in NPRM) were applicable for the broad spectrum of microvascular exercises. The arterial pulsatile flow was visually detectable and allowed side branch visualization and management. The average cost of the model was 10.7 ± 0.7 euro for OCTM and 14.1 ± 0.7 euro for NPRM. OCTM and NPRM demonstrated high surgical fidelity (OCTM: 0.86 ± 0.06; NPRM: 0.78 ± 0.1; p = 0.01) compared to the reference model (0.96 ± 0.02).

[CONCLUSIONS] The optimized non-living animal models represent efficient, reliable, and cost-effective alternatives to living-animal models for microsurgical training at different levels of expertise. Suggested models present a highly realistic simulation of pulsatile blood flow and can be effectively used to train vessel dissection, side branch management, microvascular anastomosis, bleeding control, and anastomosis patency evaluation. Perfused pulsatile non-living animal training models can be incorporated into the microsurgery training curriculum and may significantly enhance complex microsurgical skills and reduce surgical anxiety in young specialists.