A novel training model for cerebral artery anastomosis simulation by microsurgery technique

Background and Objective: In our study, we aimed to create a training model that can be used in microsurgery practice, simulates cerebral bypass surgery, is reusable, low-cost, includes chicken and turkey vessels without using live animals, includes a sensor system that will provide tactile conditioning to the surgeon, and can evaluate anastomotic stability, and how this model can be used. We aimed to evaluate the surgeon's contribution to the learning curve for microsurgery practise. aterials and Methods: For the craniotomy and cerebral surface of the cerebral bypass model, the cranium model was printed with a three-dimensional printer. Then, parenchyma was formed from the cranial mold with silicone material. In anastomoses, the dissected chicken brakial artery was prepared to represent the middle cerebral artery and the turkey brachial artery to represent the superficial temporal artery. Pressure sensitive sensors were placed on the parenchyma. The number of touches to these sensors and the touch pressure applied to the parenchyma during the anastomosis period were recorded. Tactile conditioning was provided to the surgeon with the audible warning from the sensors. The stability of the anastomoses was also evaluated by increasing the vascular pressure with the system representing the blood flow. The results of a total of 24 anastomosis trials with different sutures and different hand tools were evaluated. Results: It was shown that the time required for anastomosis decreased as the number of anastomosis practice increased (p<0.05). There was no significant difference between the anastomoses performed with portuges and forceps in terms of anastomotic leakage pressures (p>0.05). In terms of anastomosis times, there was no significant difference between the use of portuges and forceps (p>0.05). There was no statistically significant difference between the two groups in terms of the number of touching the sensor during the anastomosis (p>0.05). It was found that as the number of anastomosis practice increased, the number of touching the sensors on the parenchyma decreased (p<0.05). Conclusion: In the study, it was shown that as anastomosis practice increases, anastomosis time becomes shorter and the number of touching the sensor decreases. This demonstrates the usefulness of the training model and its contribution to the surgeon's learning curve. In our study, we have developed a model that can be used for microsurgery practice with pressure sensitive sensors, enabling the surgeon to gain tactile conditioning, evaluating anastomotic stability and leakage, low cost, reusable and easy accessibility. The development and diversification of these in vitro models for microsurgery education with advancing technologies will contribute to transforming this specialized education from being patient-based to a learning process that can be standardized and repeated in the laboratory environment.