Microsurgical training on non-living models: a systematic literature review

Preclinical training in microsurgery usually proceeds through steps of increasing difficulty. Traditionally, advanced training is carried out on living animal models which best reproduce the clinical scenario, but recently, the increasing interest in animal rights has led to a greater development and spread of different non-living models for all steps of training. The aim of this study was to identify, through a review of the literature, the inanimate models suitable for basic and intermediate/advanced training courses and to evaluate their pros and cons. The search was carried out exclusively through the PubMed database, with "microsurgery" or “supermicrosurgery” and ("training" or "non-living model") as keywords in the "title and/or abstract" fields. The filters used were: publication date (2010–2022) and species (other animals). The study was done following the PRISMA 2020 checklist criteria. A total number of 398 articles were initially screened. Following abstract review, 75 articles were selected, and 51 articles were chosen following full text review. Several non-living models are available for training on fine dissection and microsurgical technique. Among the non-animal models, food and synthetic materials (silicone tubes and latex gloves) were predominantly used. Among the non-living animals, the chicken was the most frequently used animal followed by the pig and the rat. Non-living animal mainly focus on vascular sutures on vessels of different vessels, including very small vessels for supermicrosurgery. The results of this study have shown that many different non-living models are available not only for basic microsurgical training, but also for intermediate training. These models allow to improve microsurgical and supermicrosurgical skills, simultaneously reducing the use of living animals, according to the “3 R” principle. Their main limitation is that due to their characteristics, as tissue consistency and the absence of a pumping flow, they do not provide a realistic experience as that on living animals, which are still the reference for the final phases of microsurgical training. Level of evidence:Not ratable.