<i>Ex vivo</i> model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses.

Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons.

Keywords:
Microsurgery; Heart; Anastomosis, Surgical.

Authorship

Leonardo Desessards Olijnyk Mailing address: Leonardo Desessards Olijnyk E-mail: leonardo.olijnyk@gmail.com / rodolfofigueiredocarvalho@gmail.com

Hospital Ernesto Dornelles, Department of Neurosurgery and Skull Base Surgery, Porto Alegre, RS, Brazil.Hospital Ernesto DornellesBrazilPorto Alegre, RS, Brazil Hospital Ernesto Dornelles, Department of Neurosurgery and Skull Base Surgery, Porto Alegre, RS, Brazil.

Federal University of Rio Grande do Sul (UFRGS), Institute of Basic Health Sciences, Department of Morphological Sciences, Porto Alegre, RS, Brazil.Federal University of Rio Grande do Sul (UFRGS)BrazilPorto Alegre, RS, Brazil Federal University of Rio Grande do Sul (UFRGS), Institute of Basic Health Sciences, Department of Morphological Sciences, Porto Alegre, RS, Brazil.

Rodolfo Figueiredo de Carvalho

Antonio Generoso Severino

Krunal Patel

Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada.Toronto Western HospitalBrazilToronto, Ontario, Brazil Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada.

Geraldo Pereira Jotz

Federal University of Health Sciences of Porto Alegre (UFCSPA), Department of Basic Health Sciences, Academic League of Human Anatomy, Porto Alegre, RS, Brazil.Federal University of Health Sciences of Porto Alegre (UFCSPA)BrazilPorto Alegre, RS, Brazil Federal University of Health Sciences of Porto Alegre (UFCSPA), Department of Basic Health Sciences, Academic League of Human Anatomy, Porto Alegre, RS, Brazil.

Carlos Eduardo da Silva

Marco Antônio Stefani

Mailing address: Leonardo Desessards Olijnyk E-mail: leonardo.olijnyk@gmail.com / rodolfofigueiredocarvalho@gmail.com

Conflict of interest: none.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (5)

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Figure 1
a) instruments for microsurgical training, using a bovine heart model: micro-scissors, fine tweezers, needle holder for macroscopic suture and in bayonet for microscopic suture, catheters, and syringes. Inks added to saline solution were used as dyes. The preparation of the model was carried out on a simple lab bench; b,c) initial intraluminal vessel wash to eliminate debris was performed. Initially, a needle gave greater pressure to clean vessels with coagulated blood. Then, a micro-catheter was used to infuse dye.

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Figure 2
a) catheter positioned for dye injection; b) distal vessels are less gibbous and have more tributaries; c,d) magnified dissection with the aid of blue dye for better identification of planes and perforators.

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Figure 3
a) sectioned and extended piece of bovine myocardium (larger) to execute the model. Piece of porcine myocardium (smaller) was also tested in the formulation of the proposed model. The porcine piece, despite having less adipose tissue, has smaller area for the dissection work and for micro-suture; b) piece of bovine myocardium with excess of fatty tissue. Such type of piece is commonly found in meat shops and can cause difficulty in the elaboration of the model, if unawarely acquired.

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Figure 4
Use of dye in the microscopic coronary dissection process. In this model, red and blue inks were used, what helped in the identification of planes for dissection and of perforators: a) dissected vessel without dye; b) blue dye in deep vessel; c) blue dye in vessel at the end of dissection; d,e) dissected vessel with red dye; f) vessel being prepared for section and posterior microscopy anastomosis training.

Thumbnail

Figure 5
a) dissected coronary artery; b) primary vascular suture; c) end-to-end anastomosis; d) end-to-side anastomosis. Ligature of perforating vessels was observed.

Figure 1 a) instruments for microsurgical training, using a bovine heart model: micro-scissors, fine tweezers, needle holder for macroscopic suture and in bayonet for microscopic suture, catheters, and syringes. Inks added to saline solution were used as dyes. The preparation of the model was carried out on a simple lab bench; b,c) initial intraluminal vessel wash to eliminate debris was performed. Initially, a needle gave greater pressure to clean vessels with coagulated blood. Then, a micro-catheter was used to infuse dye.

Figure 2 a) catheter positioned for dye injection; b) distal vessels are less gibbous and have more tributaries; c,d) magnified dissection with the aid of blue dye for better identification of planes and perforators.

Figure 3 a) sectioned and extended piece of bovine myocardium (larger) to execute the model. Piece of porcine myocardium (smaller) was also tested in the formulation of the proposed model. The porcine piece, despite having less adipose tissue, has smaller area for the dissection work and for micro-suture; b) piece of bovine myocardium with excess of fatty tissue. Such type of piece is commonly found in meat shops and can cause difficulty in the elaboration of the model, if unawarely acquired.

Figure 4 Use of dye in the microscopic coronary dissection process. In this model, red and blue inks were used, what helped in the identification of planes for dissection and of perforators: a) dissected vessel without dye; b) blue dye in deep vessel; c) blue dye in vessel at the end of dissection; d,e) dissected vessel with red dye; f) vessel being prepared for section and posterior microscopy anastomosis training.

Figure 5 a) dissected coronary artery; b) primary vascular suture; c) end-to-end anastomosis; d) end-to-side anastomosis. Ligature of perforating vessels was observed.

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<i>Ex vivo</i> model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses.

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[1] Mailing address: Leonardo Desessards Olijnyk E-mail: leonardo.olijnyk@gmail.com / rodolfofigueiredocarvalho@gmail.com