A Training and Testing System for Performing Vascular Reconstruction In Vitro

Summary

Here we present a training and testing system where a trainee can complete manual vascular reconstruction in vitro individually using a magnetic anchoring technique. The system can also be used to test the quality of reconstruction.

Abstract

Manual vascular reconstruction training is essential for a beginner surgeon. However, an optimal training system for vascular reconstruction in vitro has yet to be developed. In this study, we introduce an in vitro training and testing system using a magnetic anchoring technique with which a trainee can practice manual vascular reconstruction individually. Additionally, this system can also be used to test the quality of the reconstruction. The described system includes a vascular reconstruction training machine, magnetic tractors, and a magnetic suture puller. In this manuscript, we detail an end-to-end vein anastomosis using porcine right and left iliac veins. To identify the potential damage caused by a magnetic suture puller on the suture, we created three groups with six segments of 4-0 polypropylene sutures each: a control group with no intervention on the polypropylene suture, a group in which the polypropylene suture is manually pulled with sterile gloves 20x, and a magnetic puller group in which the magnetic puller pulled the polypropylene suture 20x. These groups were tested by light microscopy and breaking strength tests, and the effect of reconstruction was assessed. In the light microscopy test, the control group was less likely to be damaged (p < 0.05) and the number of damaged points of the manual group and magnetic puller group were similar (p > 0.05). The results of the breaking strength test were compared across groups and no significant difference was observed (p > 0.05). The end-to-end anastomosis of the porcine iliac veins was successfully performed using this training system, and the reconstructed veins could undergo 2.0 kPa perfusion pressure. Using this training and testing system the trainee can practice manual vascular reconstruction in vitro individually with the aid of magnetic tractors and a magnetic suture puller, and the quality of the reconstruction can be tested.

Introduction

Vascular reconstruction is a basic skill required for surgeons. Although Obora¹ and Holt² invented several mechanical reconstruction methods to simplify the reconstruction of small vessels (diameters <10 mm), these methods are not commonly applied in macrovascular anastomosis. Manual vascular anastomosis is still performed in many operations, including vascular surgery³, emergency surgery⁴, and solid organ transplantation⁵. Thus, it is essential for surgeons to practice manual vascular anastomosis. However, an optimal training system for vascular....

Protocol

The protocol was carried out in accordance with the Guidelines for the Care and Use of Laboratory Animals and was approved by the Committee on the Ethics of Animal Experiments of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.

1. Preparation prior to the training

NOTE: The vascular reconstruction training machine is shown in Figure 1. It consists of a control panel and an operating floor.

1. Click the Clean button on the control panel to clean and drain the residual liquid from the operating floor.
2. Click the Add Liquid

Results

The vascular reconstruction training machine is shown in Figure 1 and includes two main parts: the operating floor and the control panel. The operating floor consists of a water inlet, a water outlet, and a water storage basin. The two ends of the vasculature are tied to the water inlet and water outlet to test the effect of anastomosis. The length of the water outlet is adjustable, and we set the parameters (e.g., the perfusion pressure, duration of peak pressure, temperature, and pressure .......

Discussion

With the help of magnetic tractors and a magnetic suture puller, a trainee can complete vein anastomosis individually and precisely. Magnetic tractors pull the tissue that blocks the anastomosis field and provide suitable strength for stretching the veins in a vertical direction, thus achieving clear exposure for vein anastomosis. In traditional manual anastomosis, at least one assistant is required for surgical exposure. The use of magnetic tractors could achieve the required exposure and substitute for assistants. In a.......

Materials

Name	Company	Catalog Number	Comments
Circular permanent magnet	Hangzhou Permanent Magnet Group Co.LTD	20*1mm	Magnetic tractor
Magnetic balls	Hangzhou Permanent Magnet Group Co.LTD	5mm	Magnetic suture puller
Magnetic cylinders	Hangzhou Permanent Magnet Group Co.LTD	5*5mm	Magnetic suture puller
Polypropylene suture	Johnson and Johnson	PROLENE 4-0	Used for anastomosis
Silk suture	SILK	2-0，3-0	Used for fixing vascular and ligation
Surgical insturments	Jinzhong Shanghai	JZ-2018	Suture scissors, tissue scissors， forceps, needle and needle holder
Universal testing machine	Zwick GmbH&Co	Z010	Used for testing the association between the length of traction wire and the traction force