Defining Standards in Experimental Microsurgical Training: Recommendations of the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM)Tolba R.H.a · Czigány Z.b · Osorio Lujan S.c · Oltean M.d · Axelsson M.e · Akelina Y.f · Di Cataldo A.g · Miko I.h · Furka I.h · Dahmen Ui · Kobayashi E.j · Ionac M.k · Nemeth N.h
aInstitute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Aachen, Germany
bDepartment of Surgery and Transplantation, RWTH Aachen University, Aachen, Germany
cDepartment of Cardiology, Heart Institute, Children’s Hospital Colorado, Denver, CO, USA
dThe Transplantation Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
eDepartment of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
fMicrosurgery Research and Training Laboratory, Department of Orthopedic Surgery, Columbia University, New York, NY, USA
gDepartment of Oncological Surgery, University of Catania, Catania, Italy
hDepartment of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
iExperimental Transplantation Surgery, Department of General, Visceral, and Vascular Surgery, University Hospital Jena, Jena, Germany
jDepartment of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
kClinic of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
René H. Tolba, MD, PhD
Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Pauwelsstrasse 30
DE–52074 Aachen (Germany)
Norbert Nemeth, MD, PhD
Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zs. krt. 22
HU–4032 Debrecen (Hungary)
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Background: Expectations towards surgeons in modern surgical practice are extremely high with minimal complication rates and maximal patient safety as paramount objectives. Both of these aims are highly dependent on individual technical skills that require sustained, focused, and efficient training outside the clinical environment. At the same time, there is an increasing moral and ethical pressure to reduce the use of animals in research and training, which has fundamentally changed the practice of microsurgical training and research. Various animal models were introduced and widely used during the mid-20th century, the pioneering era of experimental microsurgery. Since then, high numbers of ex vivo training concepts and quality control measures have been proposed, all aiming to reduce the number of animals without compromising quality and outcome of training. Summary: Numerous microsurgical training courses are available worldwide, but there is no general agreement concerning the standardization of microsurgical training. The major aim of this literature review and recommendation is to give an overview of various aspects of microsurgical training. We introduce here the findings of a previous survey-based analysis of microsurgical courses within our network. Basic principles behind microsurgical training (3Rs, good laboratory practice, 3Cs), considerations around various microsurgical training models, as well as several skill assessment tools are discussed. Recommendations are formulated following intense discussions within the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM), based on scientific literature as well as on several decades of experience in the field of experimental (micro)surgery and preclinical research, represented by the contributing authors. Key Messages: Although ex vivo models are crucial for the replacement and reduction of live animal use, living animals are still indispensable at every level of training which aims at more than just a basic introduction to microsurgical techniques. Modern, competency-based microsurgical training is multi-level, implementing different objective assessment tools as outcome measures. A clear consensus on fundamental principles of microsurgical training and more active international collaboration for the sake of standardization are urgently needed.
© 2017 S. Karger AG, Basel
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