Name: step by step: microsurgical training method combining two nonliving animal models
Uploaded: 2015-05-09T14:00:00.000+00:00
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The authors have no acknowledgements.

1. 준비 : <ol><li> 45 배 줌에 변수 3,5 X로, 탁상 스테레오 현미경을 확보, 200mm 작동 거리, 55-75mm 변수 간 동공 거리와 액세서리 링 라이트를 이끌었다. 유사한 현미경이 작은 테이블에 설정할 수 있습니다, 적절하고 매우 비용이. </li><li> 모아 두 미세 수술 픽업, 하나 해부 가위, 한 바늘 드라이버와 미세 수술기구 세트를 준비; 이 필요 최소한이며, 이는 이러한 연습기구이며, 상한 품질 장비가 필요하지 않은 것으로 고려되어야한다. </li><li> 모든 사례에 대해 9/0 모노 필라멘트 미세 봉합사를 사용합니다. 로컬 슈퍼마켓에서 닭 허벅지 또는 날개와 식품 착색제 시판 주문. </li><li> 20 G의 angio-카테터 닭 대퇴 동맥에 개통 시험에 사용된다. 상완 동맥은 얇은 27 G 카테터가 필요합니다. 이들은 로컬 약국에서 인터넷을 통해 획득 될 수 있거나설정 악기. 식품 착색제를 주입 주사기 시판 구입. </li></ol> 2. 육안 해부 기술 : <ol><li> 대퇴 혈관에 대한 접근 방법은 간단합니다. 닭 허벅지를 들어, 무딘 해부 기술은 단지 대퇴골 간부에 내측 수행 뼈에서 대퇴 근육을 분리하고, 대퇴 동맥, 정맥 신경을 노출. 신경은 더 신경 수리 관행의 다른 유형에 대한 두 개의 다발로 해부 할 수 있습니다. </li><li> 날개의 끝 부분까지 어깨, 가위로 길이 방향으로 피부를, 닭 날개에 닭 상완 동맥을 절개에 액세스하기 위해. 이두근과 삼두근 상완 사이에 실행하는 동맥을 관찰한다. </li></ol> 3. 권장 훈련식이 요법 : <ol><li> 대퇴 동맥과 훈련. 주 : 훈련 요법의 첫 번째 단계는 닭 대퇴 동맥 연습한다. </li></ol><ol><li> 현미경으로 조각을 배치하고 미세 수술 절개를 시작합니다. 기본 조직에서 대퇴 동맥 무료; 수평으로 나눕니다. adventicectomy을 수행합니다. 동맥 내강 위에 놓인 어떤 adventicia 트림 마이크로 픽업 및 마이크로 가위를 사용합니다. 일반 수돗물로 내부 루멘을 씻어. 시작 시간을 기록 </li><li> 문합을 종료 종료를 수행합니다. <ol><li> 운영자 반대측 동맥 뒷벽에 시작한다. 첫 번째 스티치를 놓고; 수직으로 작동하는 경우, 하측에 가로로 작동하는 경우, 좌측에 시작한다. 동맥의 외측 루멘으로부터 다음 동맥 내강쪽으로의 외부에서 바늘 합격. </li><li> 스티치 타이 최초의 이중 매듭을 수행 한 다음 두 개의 싱글 교류 방향을 던졌습니다. 상기 기술로 전체 다시 벽을 완료합니다. </li><li> 만약 하시다하고 있으면 가로 작업 또는 상측 경우 오른쪽부터수직 rking, 외측 루멘으로부터 다음 루멘 외부로부터 단일 스티치를 배치하고. 전술 한 바와 같이 매듭을 묶어. 3.1.2.2에 기재된 절차를 반복 전벽 완료. </li><li> 이것은 당신이 시간 기록을 유지 할 수 있도록 마지막 시간을 기록, 그래서 당신은 당신의 진행을 제어 할 수 있습니다. 주 : 저자는 하나의 방식으로 기술을 선호한다; 그러나 미세 수술 봉합사의 어떤 유형은 훈련 될 수있다. 그가 다른 임상 시나리오를 시도하기 전에 연수생이 방법으로 약 25 미세 수술 문합을 완료 것을 권장합니다. 이들은 정맥 동맥 갭위한 그 래프팅, 신경 수리 끝과 끝, 및 신경 갭의 치료를위한 정맥 도관의 사용을 포함한다. 이 훈련 방법으로 배울 수있는 미세 혈관 수술의 중요한 기술은없는 3.1.2.1에서와 같이 바늘을 수행하기 위해 계속 3.1.2.1로이 기술을 연수 진행을 수행 할 수 있지만, 스티치가 절단되지 않고, 연속 또는 실행 봉합입니다 그들에게 U 절단ntil는 전체 봉합사를 완성하고 마지막에 원래 스티치에 넥타이. </li></ol></li></ol><ol start="2"><li> 상완 동맥와 교육 <ol><li> 현미경으로 조각을 놓습니다. 대퇴부 동맥에 대해 상술 한 바와 같이 절차를 완료. 주 : 유일한 차이점은 크기입니다. 상완 동맥은 대퇴 동맥보다 훨씬 작고 문합은 상당히 도전이다. </li></ol></li><li> 개통 테스트 <ol><li> 함께 모두 혈관 벽을 봉합 바늘에 의한 방해를 확인하기 위해, 문합을 통해 부드러운 20 27 G의 angio-카테터를 교차. </li><li> 제트 누설 테스트하기 위해 동맥에 염료 angio-카테터의 끝으로 상용 식품 착색제와 주사기를 적용하고 관류 </li><li> 바늘, 자신의 병렬 처리 및 촬영 벽의 양을 시각화하기 위해 길이 방향으로 동맥을 엽니 다. </li></ol></li></ol>

<ol>
	<li>Lee, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Historical+events+on+development+of+experimental+microsurgical+organ+transplantation.">Historical events on development of experimental microsurgical organ transplantation.</a> Yonsei Med J. 45 (6), 1115-1120 (2004).</li><li>Shurey, S., Akelina, Y., Legagneux, J., Malzone, G., Jiga, L., Ghanem, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+rat+model+in+microsurgery+education:+classical+exercises+and+new+horizons.">The rat model in microsurgery education: classical exercises and new horizons.</a> Arch Plast Surg. 41 (3), 201-208 (2014).</li><li>Olabe, J., Olabe, J., Sancho, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+cadaveric+infusi&#243;n+model+for+neurosurgical+training.">Human cadaveric infusi&#243;n model for neurosurgical training.</a> Surg Neurol. 72, 700-702 (2009).</li><li>Peled, I. J., Kaplan, H. Y., Wexler, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsilicone+anastomoses.">Microsilicone anastomoses.</a> Ann Plast Surg. 10 (4), 331-332 (1983).</li><li>Gluer, N. M., Rao, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Canniesburn+&#8220;ever-ready&#8221;+model+to+practise+microsurgery.">Canniesburn &#8220;ever-ready&#8221; model to practise microsurgery.</a> Br J Plast Surg. 43 (3), 381-382 (1990).</li><li>Hino, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Training+in+microvascular+surgery+using+a+Chicken+wing+artery.">Training in microvascular surgery using a Chicken wing artery.</a> Neurosurgery. 52 (6), 1495-1498 (2003).</li><li>Marsh, D. J., Norton, S. E., Mok, J., Patel, H. D., Chen, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+training+the+Chicken+thigh+model.">Microsurgical training the Chicken thigh model.</a> Ann Plast Surg. 59 (3), 355-356 (2007).</li><li>Jeong, H. S., Moon, M. S., Kim, H. S., Lee, H. K., Yi, S. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+training+with+fresh+chicken+legs+and+their+histological+characteristics.">Microsurgical training with fresh chicken legs and their histological characteristics.</a> Ann Plast Surg. 70 (1), 57-61 (2013).</li><li>Couceiro, J., Ozyurekoglu, T., Sanders, S., Tien, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+training+regimen+with+nonliving+chicken+models.">Microsurgical training regimen with nonliving chicken models.</a> Microsurgery. 33 (3), 251-252 (2013).</li><li>Phoon, A. F., Gumley, G. J., Rtshiladze, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+training+using+a+pulsatile+membrane+pump+and+chicken+thigh:+A+new,+realistic,+practical,+nonliving+educational+model.">Microsurgical training using a pulsatile membrane pump and chicken thigh: A new, realistic, practical, nonliving educational model.</a> Plast Reconstr Surg. 126 (5), 278e-279e (2010).</li><li>Zhou, Y., Gu, X., Xiang, J., Qian, S., Chen, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparative+study+on+suture+versus+cuff+anastomosis+in+mouse+cervical+cardiac+transplant.">A comparative study on suture versus cuff anastomosis in mouse cervical cardiac transplant.</a> Exp Clin Transplant. 8 (3), 245-249 (2010).</li></ol>

The authors have nothing to disclose.

The clinical practice of microsurgery requires a continuous practice and a high level of expertise; it&#8217;s applications include free flaps, replantation and revascularization procedures, intracranial &#8211; extracranial anastomoses for neurosurgical procedures, peripheral nerve surgery and others. In spite of the wide variety of procedures that require microsurgical techniques, some of them are seldom performed in many centers. The surgeons therefore need sometimes to maintain their skill level rehearsing the surgeries on different practice models. 
The most widely spread training model is currently the rat 1,2; it is considered by many to be the &#8220;gold standard&#8221; in microsurgical instruction. Rats are indeed a very valuable tool in the teaching and learning of microsurgery. They provide a very similar environment to that of the clinical situation. This approach however exhibits some intrinsic limitations. The use of living animals presents an ethical dilemma; and is generally subjected to institutional review board approval. Furthermore they require anesthesia, and dedicated technicians and facilities. All These factors imply important economic costs; this restricts training on living animals to specific teaching units, experimental surgery departments and hospitals with similar resources. 
The use of nonliving animal models described in this protocol, has the advantage of not raising any ethical concerns; it does not require institutional review board approval. Economically it compares favorably to living animal training. The required equipment is limited and can be acquired over the internet for a reasonable price; the author&#8217;s tabletop stereomicroscope was bought for around 450 United States Dollars (USD) and the set of practice microsurgical instruments was purchased for around 150 USD. The author uses microsurgical sutures provided by his sponsoring institution; the price of sutures varies greatly and high quality sutures are not needed, a box of twelve sutures can be bought for around 70 USD on the internet. A microsurgical training station can be set up on a very limited area at home or at work; Jeong et al.8 Placed their microscope at the residents&#8217; office; whilst we9 used an available microscope close to the hand surgery fellows&#8217; quarters. 
The most critical point in the application of this protocol is the need for the trainee to be constant and to stay motivated with his training, it is therefore very important that he starts training with the bigger vessels first and then proceed to the smaller chicken wing vessels to avoid frustration. The limitations of training with nonliving models involve primarily the lack of bleeding and the inexistence of hemodynamic phenomena like vasospasm and clotting. The advantages and disadvantages of this type of training are summarized on Table 1. The three tests detailed in section three are aimed to help the trainee check the vessel&#8217;s patency in the absence of the earlier mentioned phenomena; they provide information on the quality of the trainee&#8217;s suture, leaking, suture misalignment, and lumen obstruction caused by stitches suturing the front and back wall together. 
The protocol can potentially be improved by the addition of a peristaltic pump10 to simulate vessel flow or by flooding the field with liquid to simulate superficial tension. It is the authors opinion that this would result in the production of an even more realistic training environment and this should be the direction of future research. 
Another possible field for development is the application of this training method to help the trainee learn more complex procedures, such as the cuff anastomosis technique11 before it&#8217;s actual application on animal research. The authors have however no experience with such techniques at present time. 
In conclusion the protocol described in the present manuscript allows a determined trainee to setup a small practice station and use it to learn, perfect and maintain microsurgical skills progressively and sustainably; without the need for special facilities and minimizing animal deaths.

An ample array of training models have been described for the learning and maintenance of both basic and advanced microsurgical skills. These include living animals1,2, human cadaveric specimens3, inert models4,5 and non-living animal models6-9.The Living animal models, specifically those using rats have been extensively used in the teaching of microsurgery 1,2; and they are considered the current gold standard of training. In spite of their remarkable instructive value, when an intensive or prolonged training is required; economical and ethical concerns can hinder their practical usage. 
Cadaveric models3 offer the opportunity to practice in an environment similar to that of the actual clinical situation; they are unfortunately restricted to anatomy labs and similar facilities, a microscope must be available at the lab as well; these models are therefore not widely available. Inert models such as rubber tubes, or gloves4,5 are cheap, and easily accessible, the required equipment for their application is minimal. The resemblance to a clinical situation is tenuous however; and their application is generally limited to the introductory stages of training, before the trainee starts practicing on rats. To the best of our knowledge Hino6 was the first to propose the use of non-living chicken for the development and maintenance of clinical microsurgical skills. His model is based on the extraction and subsequent usage of the chicken brachial artery from commercial chicken wings. This approach does not need institution review board approval, rodent anaesthesia, laboratory technicians or postoperative care. 
Following Hino&#180;s description of the chicken wing artery model numerous other nonliving animal models were published. The use of commercial chicken thighs was first suggested by Marsh et al.7 who reported the use of the femoral artery, vein and nerve for didactic purposes. This particular model expands the possibilities of training including structures different from the arteries; it permits the trainee to perform a variety of complex procedures such as vein grafts, nerve grafts or fascicular repairs. Jeong et al.8 Further studied Marsh&#8217; chicken thigh model and its applications to the teaching of resident doctors. The authors analysed chicken tissue samples histologically and found that it presented similarities to human tissues. The time to perform an anastomosis by the trainee was significantly reduced by practice in their study. They concluded that &#8220;the femoral neurovascular bundles of chicken are an appropriate and effective model for teaching and practicing microsurgery&#8221;. In 2013 my colleagues and I9 published a microsurgical training regimen that combined both the chicken thigh and the chicken wing models; this approach benefits from the versatility of the chicken thighs and from the limited size of the chicken wing artery which can represent more of a challenge than the femoral vessels for the more advanced trainees. 
On the current manuscript we describe step by step the process of setting up a microsurgical practice station; the materials required, how to dissect the neurovascular structures of each model and how to effectively apply the training regimen.

<table><tbody><tr><td>Stereomicroscope</td><td>Amscope</td><td>SM-1BX</td><td>Microscope</td></tr><tr><td>Led light</td><td>Amscope</td><td>LED-80S-YA</td><td>illumination system</td></tr><tr><td>Microsurgical instruments set</td><td>Chen hen microsurgical instruments</td><td>HC- X803-1</td><td>Microsurgical instruments</td></tr><tr><td>Microsurgical sutures</td><td>S/T microsurgical</td><td>9/0 Suture</td><td>Sutures</td></tr></tbody></table>

step by step: microsurgical training method combining two nonliving animal models

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly laboratory rats. This method although extremely valuable can be economically demanding both for the surgeon and the sponsoring institution; it also requires special training facilities that may not always be available or accessible. Furthermore ethical concerns can limit the use of living animals for training purposes. Alternative training methods, such as inert tubes and gloves have not gained popularity among surgeons since they do not offer an experience similar to that of a clinical situation. Non-living animal models include the use of chicken thighs and wings; they offer a practice experience that resembles a clinical situation to a considerable extent. This type of training is relatively cheap and easily available. The microscope and instruments required can be acquired over the internet, and the chicken pieces can be bought at the local supermarket.
This approach allows a motivated trainee to rehearse different types of surgical techniques several times at a reasonable expense, helping to develop or maintain his surgical expertise if more complex facilities are not available. On the current manuscript we describe how to setup a small practice station, how to dissect the specimens, and how to practice both with the chicken thighs and with the chicken wings in a progressive fashion. This approach takes advantage on the versatility of the chicken thigh model and the small size of the chicken wing Brachial artery.

저자는 본 교육 방법으로 자신의 시간을 chronometered하고 크게 세 번째 주말에 대퇴 동맥의 문합 시간을 단축하기 위해 그것을 보았다. 연수생은 자신의 시간, 자신의 개통 비율과 그의 바늘의 정렬을 체크하여 자신의 기술에 개선을 제어 할 수 있습니다. 이 논문에 설명 된 시스템으로는 탁상 현미경 및 미세 수술 도구의 세트를 포함하고도 1에 도시되어있다. 거시적 해부은 그림 2와 3 대퇴 동맥 미세 수술 문합의 예에 표시된 4. 그림 5는 상완 동맥 미세 수술 문합을 보여줍니다 그림에 표시됩니다. 그림 6은 정맥 이식술과 대퇴 동맥 수리를 보여줍니다. 개통 시험은도 7에 도시된다. <img alt="그림 1" src="/files/ftp_upload/52625/52625fig1.jpg" /> 그림 1 : CORR저자 자신의 미세 수술 연습 역을 esponding. 그것은 탁상 현미경과 미세 수술기구 훈련의 집합이 포함되어 있습니다. 그것은 사무실이나 가정에서 매우 제한된 공간을 설정할 수 있습니다. <img alt="그림 2" src="/files/ftp_upload/52625/52625fig2.jpg" /> 그림 2 : 닭 허벅지의 거시적 해부, 대퇴 혈관과 좌골 신경은 쉽게 손가락 그냥 대퇴골 간부에 내측 실행 노출 될 수 있습니다. 수평 화살표는 대퇴골을 표시합니다. 절개면 그냥 대퇴골 B 평행 수직 화살표로 표시된다 : 대퇴 동맥은 (a) (V) 및 좌골 신경 (n)은 여기에서 상세하게 도시되어 정맥. <img alt="그림 3" src="/files/ftp_upload/52625/52625fig3.jpg" /> 그림 3과 B : 닭 날개의 거시적 해부. 상완<html> rtery은 이두근과 삼두근 상완 사이에 실행됩니다. 동맥은 모두 사진이 매우 피상적​​이고 방법은 간단에 화살표로 표시되어; 그것은 상업 요리 가위로 달성 될 수있다. <img alt="그림 4" src="/files/ftp_upload/52625/52625fig4.jpg" /> 그림 4 : 봉합을 종료 대퇴 동맥 끝의 미세한 이미지, 하나의 바늘 여기에 하나의 방식으로 기술 하였다. 봉합사 임의의 다른 유형은 훈련생의 재량에 실시 될 수있다. <img alt="그림 5" src="/files/ftp_upload/52625/52625fig5.jpg" /> 그림 5 : 닭 상완 동맥의 봉합을 끝으로 종료합니다. 이 대퇴 동맥의 것보다 훨씬 작으며 절차는 훨씬 더 기술적으로 요구하고있다. 로드 / 52625 / 52625fig6.jpg &quot;/&gt; 그림 6 : 대퇴 정맥에서 수확 정맥 이식술과 대퇴 동맥 수리. 닭 허벅지 모델은 매우 다양한 연습의 다른 유형을 허용한다. <img alt="그림 7" src="/files/ftp_upload/52625/52625fig7.jpg" /> 그림 7 :. 개통 시험 : 적절한 직경의 angio-카테터는 혈관의 벽을 모두 봉합 stiches에 의한 장애물을 확인하는 문합을 통해 교차 B :.. 염료가 누설 테스트 문합을 통해 관류는 C : 문합은 봉합 정렬을 시각화하기 위해 길이 방향으로 열립니다.

Watch this Scientific Journal Video about Step By Step: Microsurgical training method combining two nonliving animal models at JoVE.com

Step By Step: Microsurgical training method combining two nonliving animal models

단계적으로 두 생명이 동물 모델을 결합 미세 수술 훈련 방법

Here we describe how to set up a small microsurgical practice station and a simple and inexpensive method for the training of microsurgery with non-living animal models.

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly ...

step-step-microsurgical-training-method-combining-two-nonliving

Universidad San Sebastian

Research

JoVE Journal

Medicine

15.2K 조회수.  POVISA Hospital. Here we describe how to set up a small microsurgical practice station and a simple and inexpensive method for the training of microsurgery with non-living animal models. 

비디오: Step By Step: Microsurgical training method combining two nonliving animal models

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression must be pursued. Employing vascularized bone marrow transplantation and co-transplantation of the thymus have shown promise in this regard in various animal models.1-11 Vascularized bone marrow transplantation allows for the uninterrupted transfer of donor bone marrow cells within the preserved donor microenvironment, and the incorporation of thymus tissue with vascularized bone marrow transplantation has shown to increase T-cell chimerism ultimately playing a supportive role in the induction of immune regulation. The combination of solid organ and vascularized composite allotransplantation can uniquely combine these strategies in the form of a novel transplant model. Murine models serve as an excellent paradigm to explore the mechanisms of acute and chronic rejection, chimerism, and tolerance induction, thus providing the foundation to propagate superior allograft survival strategies for larger animal models and future clinical application. Herein, we developed a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique. The experience in syngeneic and allogeneic transplant settings is described for future broader immunological investigations via an instructional manuscript and video supplement.

To study combined solid organ and vascularized composite allotransplantation, we describe a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique.

마우스의 소설 미세 수술 이소성 모델, 욕실 공산권 가슴 벽, 흉선, 및 심장 이식

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression ...

연구

의학

Preparation of Murine Submandibular Salivary Gland for Upright Intravital Microscopy

The submandibular salivary gland (SMG) is one of the three major salivary glands, and is of interest for many different fields of biological research, including cell biology, oncology, dentistry, and immunology. The SMG is an exocrine gland comprised of secretory epithelial cells, myofibroblasts, endothelial cells, nerves, and extracellular matrix. Dynamic cellular processes in the rat and mouse SMG have previously been imaged, mostly using inverted multi-photon microscope systems. Here, we describe a straightforward protocol for the surgical preparation and stabilization of the murine SMG in anesthetized mice for in vivo imaging with upright multi-photon microscope systems. We present representative intravital image sets of endogenous and adoptively transferred fluorescent cells, including the labeling of blood vessels or salivary ducts and second harmonic generation to visualize fibrillar collagen. In sum, our protocol allows for surgical preparation of mouse salivary glands in upright microscopy systems, which are commonly used for intravital imaging in the field of immunology.

We describe a protocol to surgically expose and stabilize the murine submandibular salivary gland for intravital imaging using upright intravital microscopy. This protocol is easily adaptable to other exocrine glands of the head and neck region of mice and other small rodents.

똑바로 Intravital 현미경 Murine Submandibular 침 샘의 준비

The submandibular salivary gland (SMG) is one of the three major salivary glands, and is of interest for many different fields of biological research, ...

면역학 및 감염병학

Surgical Training for the Implantation of Neocortical Microelectrode Arrays Using a Formaldehyde-fixed Human Cadaver Model

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. Recent technological progress has enabled the fabrication of microelectrode arrays that allow recording the activity of multiple individual neurons in the neocortex of the human brain. These arrays have the potential to bring unique insight onto the neuronal correlates of cerebral function in health and disease. Furthermore, the identification and decoding of volitional neuronal activity opens the possibility to establish brain-computer interfaces, and thus might help restore lost neurological functions. The implantation of neocortical microelectrode arrays is an invasive procedure requiring a supra-centimetric craniotomy and the exposure of the cortical surface; thus, the procedure must be performed by an adequately trained neurosurgeon. In order to provide an opportunity for surgical training, we designed a procedure based on a human cadaver model. The use of a formaldehyde-fixed human cadaver bypasses the practical, ethical and financial difficulties of surgical practice on animals (especially non-human primates) while preserving the macroscopic structure of the head, skull, meninges and cerebral surface and allowing realistic, operating room-like positioning and instrumentation. Furthermore, the use of a human cadaver is closer to clinical daily practice than any non-human model. The major drawbacks of the cadaveric simulation are the absence of cerebral pulsation and of blood and cerebrospinal fluid circulation. We suggest that a formaldehyde-fixed human cadaver model is an adequate, practical and cost-effective approach to ensure proper surgical training before implanting microelectrode arrays in the living human neocortex.

We designed a procedure in which a formaldehyde-fixed human cadaver is used to assist neurosurgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain.

외과 훈련 Neocortical Microelectrode 배열 포름알데히드 고정 인간 수 색 모델을 사용 하 여 이식에 대 한

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. ...

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes have been available for years in many surgical fields. We used the female (because they are easy to handle for the procedure) Yorkshire pigs for the head and neck reconstruction by harvesting the deep inferior epigastric artery perforator or the superior epigastric artery perforator flap. The anastomosis site (neck skin defect or tracheal wall defect) was prepared via the dissection of the common carotid artery and the internal jugular vein, in which 3.5&#215; loupe magnification was used for anastomosis as we use on human cases in real life. This procedure demonstrates a new training method using a reliable learning model and provides a detailed anatomy in a live scenario. We focused on the ischemia time, harvesting, vessel anastomosis, and designing the flap to fit the defect site. This model improves tissue handling and with the use of proper instruments can be repeated many times so that the surgeon is fully confident before starting the surgery on humans.

Here we present a protocol for the use of the pig superior epigastric artery perforator flap as a learning module for head and neck microvascular reconstruction.

돼지 머리와 목 Microvascular 재건을 위한 훈련 모듈

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes ...

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course &#34;Lary-Gym&#34;. Further perspectives on robotic surgical training are described.

The purpose of this paper is to illustrate how to organize a reproducible laboratory for laryngeal surgery on affordable and closely similar animal laryngeal models in order to improve anatomical and surgical knowledge and skills.

해부 실험실에서 현대 후두 수술 배우기

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is ...

A Revised Method for Inducing Secondary Lymphedema in the Hindlimb of Mice

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore potential treatment options. This mouse model allows researchers to induce significant lymphedema lasting at least 8 weeks. Lymphedema is induced using a combination of fractioned radiotherapy and surgical ablation of lymphatics. This model requires that the mice get a dose of 10 Gray (Gy) radiation before and after surgery. The surgical part of the model involves ligation of three lymph vessels and extraction of two lymph nodes from the mouse hindlimb. Having access to microsurgical tools and a microscope is essential, due to the small anatomical structures of mice. The advantage of this model is that it results in statistically significant lymphedema, which provides a good basis for evaluating different treatment options. It is also a great and easily available option for microsurgical training. The limitation of this model is that the procedure can be time consuming, especially if not practiced in advance. The model results in objectively quantifiable lymphedema in mice, without causing severe morbidity and has been tested in three separate projects.

This animal model enables researchers to induce statistically significant secondary lymphedema in the hindlimb of mice, lasting at least 8 weeks. The model can be used to study the pathophysiology of lymphedema and to investigate novel treatment options.

마우스의 힌들보에서 보조 림프부종을 유도하기위한 개정 된 방법

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore ...

Modeling Stroke in Mice: Focal Cortical Lesions by Photothrombosis

Stroke is a leading cause of death and acquired adult disability in developed countries. Despite extensive investigation for novel therapeutic strategies, there remain limited therapeutic options for stroke patients. Therefore, more research is needed for pathophysiological pathways such as post-stroke inflammation, angiogenesis, neuronal plasticity, and regeneration. Given the inability of in vitro models to reproduce the complexity of the brain, experimental stroke models are essential for the analysis and subsequent evaluation of novel drug targets for these mechanisms. In addition, detailed standardized models for all procedures are urgently needed to overcome the so-called replication crisis. As an effort within the ImmunoStroke research consortium, a standardized photothrombotic mouse model using an intraperitoneal injection of Rose Bengal and the illumination of the intact skull with a 561 nm laser is described. This model allows the performance of stroke in mice with allocation to any cortical region of the brain without invasive surgery; thus, enabling the study of stroke in various areas of the brain. In this video, the surgical methods of stroke induction in the photothrombotic model along with&#160;histological analysis are demonstrated.

Described here is the photothrombotic stroke model, where a stroke is produced through the intact skull by inducing permanent microvascular occlusion using laser illumination after administration of a photosensitive dye.

마우스에서 뇌졸중 모델링: 포심 피질 병변

Stroke is a leading cause of death and acquired adult disability in developed countries. Despite extensive investigation for novel therapeutic strategies, ...

신경과학

Generating Murine Model of Myocardial Infarction: A Surgical Procedure for Permanent Ligation of Left Anterior Descending Coronary Artery in Mouse Model

Source: Lugrin, J. et al. <a href="https://www-jove-com.bdigitaluss.remotexs.co/video/59591" target="_blank">Murine Myocardial Infarction Model using Permanent Ligation of Left Anterior Descending Coronary Artery</a>. J. Vis. Exp. (2019)
In this video, we describe a surgical procedure to generate a mouse model of myocardial infarction by permanently ligating the left anterior descending coronary artery.

심근경색의 쥐 모델 생성: 마우스 모델에서 좌측 전방 하행 관상동맥의 영구 결찰을 위한 수술 절차

Source: Lugrin, J. et al. Murine Myocardial Infarction Model using Permanent Ligation of Left Anterior Descending Coronary Artery. J. Vis. Exp. (2019)
In ...

JoVE Encyclopedia of Experiments

생물학

Rodent Models

Adult

Fluorescence-guided Tumor Resection and MSC-seeded Scaffold Implantation in Murine Model: A Surgical Procedure to Deliver Therapeutic Mesenchymal Stem Cells into Brain Tumor Resection Cavity in Mouse Model

Source: Sheets, K. T. et al. <a href="https://www-jove-com.bdigitaluss.remotexs.co/video/57452" target="_blank">Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds.</a>&#160;J. Vis. Exp.&#160;(2018)
This video presents the surgical procedure for image-guided tumor resection and implantation of a bio-scaffold seeded with genetically engineered mesenchymal stem cells or MSCs expressing tumor necrosis factor-related apoptosis-inducing ligand or TRAIL. These therapeutic MSCs have the potential in treatment of brain tumors.

쥐 모델에서 형광 유도 종양 절제 및 MSC 시드 골격 이식: 마우스 모델에서 뇌 종양 절제강에 치료용 중간엽 줄기세포를 전달하는 수술 절차

Source: Sheets, K. T. et al. Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds.&#160;J. Vis. ...

암 연구학

Cancers of the Nervous System

In vivo studies

Filament Insertion-based Transient Stroke Model: A Surgical Procedure to Perform Middle Cerebral Artery Occlusion in Murine Brain

Source: Llovera, G., et al. <a href="https://www-jove-com.bdigitaluss.remotexs.co/v/62573">Modeling Stroke in Mice: Transient Middle Cerebral Artery Occlusion via the External Carotid Artery.</a> J. Vis. Exp (2021).
This video describes the procedure to develop transient stroke in a murine model using silicon-coated filament-based occlusion of the middle cerebral artery.&#160;The developed model mimics human stroke, thus helping to investigate novel therapeutic strategies for treating stroke.

필라멘트 삽입 기반 일시적 뇌졸중 모델: 쥐뇌에서 중대뇌동맥 폐색을 수행하기 위한 수술 절차

Source: Llovera, G., et al. Modeling Stroke in Mice: Transient Middle Cerebral Artery Occlusion via the External Carotid Artery. J. Vis. Exp (2021).
This ...