Apprentissage des techniques microchirurgicales vasculaires sur un modèle animal

Abstract

IntroductionThe aim of this study was to assess the progress of an operator, during microsurgical training, on a bilateral carotid revascularization in the rat. Material and methodsIn this prospective study, nine rats underwent bilateral carotid revascularization. An end-to-end graft of the right carotid artery by the facial vein and an end-to-side bypass of left carotid artery by the jugular external vein were performed. Anastomoses were carried out with 10/0 thread, based on the technique of the symmetric bi-angulation. At the end of procedure, a permeability test was performed on each anastomosis. Duration of survival of the animal, permeability of anastomosis, and evolution of the operating periods during the training were collected and respectively analyzed with a Fisher's and Student's t tests. In cases of procedure success, anastomoses were remotely controlled and a brain dissection was performed in order to seek a possible ischemia due to carotid clamping. In the event of failure, the rat was sacrificed and anastomoses were opened in order to establish the cause of thrombosis. ResultsTwo thirds of the revascularization procedures were successful. A total of 83.3% of the anastomoses were patent. Of the six rats preserved for remote evaluation of anastomoses, three died. Remotely controlled anastomoses remained all permeable. No cerebral ischemia, associated with carotid clamping (approximately 45minutes), was highlighted by brain dissection. With the growing experience of the operator, an improvement in results in mastery of the technique was objectively observed. Operative durations were reduced between the beginning and the end of the training: −54minutes (P=0.001). ConclusionMicrosurgical laboratory training seems to be essential in order to acquire the dexterity, ease and experience necessary for performing microsurgical procedures in humans.