A training tool for lymphatic vessel anastomosis in supermicrosurgery: An ultrafine polyvinyl alcohol tube
A training tool for lymphatic vessel anastomosis in supermicrosurgery: An ultrafine polyvinyl alcohol tube
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超显微外科淋巴管吻合训练工具：超细聚乙烯醇管
DOI：
10.1002/micr.30625
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发表时间：
2020
期刊：
影响因子：
2.1
通讯作者：
Shuji Yamashita
中科院分区：
文献类型：
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作者：
E. Kobayashi;Shuji Yamashita
光学和显微外科工具的进步使最小的血管、神经和淋巴管的切除成为可能。因此，越来越多的实践课程由该领域的专家进行（Pappalardo，Chang，Masia，Koshima和Cheng，2020）。已经引入了一些在活体大鼠中使用小血管的模型（Malagón-López，Carrasco-López，Vilà，Pi-Folguera，& Higueras-Suñe，2019; Zheng，Corvi，Nicolas，& Akelina，2019）。早些时候，欧洲外科研究学会（ESSR）和国际实验显微外科学会（ISEM）合作推荐使用处死动物的人造血管或脉管系统进行训练，以尽可能减少手术训练中使用的活体动物数量（Tolba et al.，2017年）。然而，使用人造管进行训练的问题在于，用于管的薄度和材料与活体的薄度和材料显著不同。在先前的报道中，据报道，聚乙烯醇（PVA）管比硅树脂管更类似于活体的血管，因此适用于训练糖尿病（Atlan等人，2018年）。在这里，我们介绍了一个人工训练产品，由原来的PVA，我们开发的淋巴吻合超显微手术的做法。根据聚乙烯醇的聚合度、皂化度和含水率对聚乙烯醇的组织进行了改性。该产品的独特之处在于将几种PVA混合，然后调节冷冻交联剂的温度和时间，以使其质地类似于活体的淋巴管。该模型为聚乙烯醇管（PVA管），制作方法如下：将聚乙烯醇（PVA）水溶液倒入雕刻成淋巴管形状的模具中，然后溶液在模具内凝胶化，形成质地柔软的淋巴管模型。产品的硬度可通过PVA类型和溶液浓度来控制。在我们早期开发的新型8 K视频显微镜下进行假淋巴管吻合术（图1A）（小林和Yamashita，2020）。人工淋巴管的管腔尺寸为0.3- 0.4mm，其外径为0.5- 0.6mm，具有高度的柔软性，与活体的淋巴管非常相似。超显微外科专家（SY）还在临床显微镜下对超细PVA管进行了测试。他认为PVA管材料柔软，管腔通过切割闭合，能够再现与实际淋巴管相同的条件（图1B）。可以使用12-0缝针进行吻合，而无需弯曲缝针（图1C）。当用镊子和针处理它们时，该管与活体的淋巴管非常相似，并且用12-0线缠绕。毫无疑问，使用大鼠神经和血管的超显微外科训练模型也是有用的。然而，由于动物福利和大型实践研讨会的卫星场地问题，该产品被认为非常有用。
Dear Editor Advances in optics and microsurgery tools have made it possible to anastomose the smallest blood vessels, nerves, and lymph vessels. Accordingly, there is an increasing number of hands-on courses being conducted by experts in this field (Pappalardo, Chang, Masia, Koshima, & Cheng, 2020). A few models using small blood vessels in a living rat have been introduced (Malagón-López, Carrasco-López, Vilà, Pi-Folguera, & Higueras-Suñe, 2019; Zheng, Corvi, Nicolas, & Akelina, 2019). Earlier, the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM) collaborated to recommend training using artificial blood vessels or vasculature of sacrificed animals, to minimize the number of living animals used in surgical training as much as possible (Tolba et al., 2017). However, the problem with training using artificial tubes is that the thinness and the material used for the tubes are remarkably different to those of a living body. In a preceding report, polyvinyl alcohol (PVA) tubes were reported to be more similar to blood vessels of a living body than silicone tubes, thus suitable for use for training of anastomoses (Atlan et al., 2018). Here, we are introducing an artificial training product made by an original PVA which we developed for lymphatic anastomosis practices in supermicrosurgery. The texture of PVA was modified according to the degree of its polymerization, saponification and the percentage of moisture content. The unique feature of the product was achieved by mixing several PVA and then adjusting the temperature and time of frozen cross-linking agent in order to make the texture similar to a lymph vessel of a living body. This model is a polyvinyl alcohol tube (PVA tube), and the manufacturing method is as follows: a polyvinyl alcohol (PVA) aqueous solution is poured into a mold carved into the shape of a lymph vessel, and the solution then gelates inside the mold to form a lymph vessel model with a soft texture. The hardness of the product can be controlled by the PVA type and solution concentration. Pseudo-lymphatic vessel anastomosis was performed under a new 8K video microscope that we developed earlier (Figure 1A) (Kobayashi & Yamashita, 2020). The size of the lumen of an artificial lymphatic vessel was 0.3–0.4 mm, and its outer diameter was 0.5–0.6 mm, with a high degree of softness, closely resembling the lymphatic vessels of a living body. The ultrafine PVA tube was also tested by an expert (SY) in supermicrosurgery under clinical microscopy. He felt that the PVA tube material was soft and the lumen closed with cutting, enabling reproduction of the same condition as that of actual lymphatic vessels (Figure 1B). It was possible to perform anastomosis with a 12–0 needle without bending the needle (Figure 1C). The tube was remarkably similar to the lymphatic vessels of a living body when handling them with the forceps and a needle, and suturing with 12–0 threads. There is no doubt that supermicrosurgery training models using rat lymphatics and blood vessels are also useful. However, this product is considered extremely useful, due to animal welfare and satellite venue issues at large hands-on seminars.
Hiromasa Kobayashi 等人：“AtT-20 小鼠垂体肿瘤细胞上的促肾上腺皮质激素释放因子 (CRH) 受体。”
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