BACKGROUND: Cerebral revascularization in the deep surgical field is technically challenging. Especially, side-to-side anastomosis like A3-A3 could be technically more difficult compared with end-to-side anastomosis. To improve surgeon's dexterity and maneuverability in the deep surgical field, the authors developed an easily accessible and well-simulating training system using prosthetic tubes and a box. METHODS: Two prosthetic tubes (silicon tube, 1.2 mm in diameter) are mounted in parallel on the bottom of 6.5-cm-deep emptied 'tissue paper box.' The orifice of the box is restricted to 2 x 2 cm to simulate a deep and narrow surgical corridor. Using bayonet-shaped micro needle holder and forceps, the side-to-side anastomosis of the tubes is performed with 10-0 nylon under operative microscope. RESULTS: Prosthetic tubes well simulated real A3-A3 anastomosis. From the standpoint of technical difficulty, this training system needed slightly higher level of dexterity compared with real A3-A3 anastomosis because of narrower and deeper surgical corridor, and the wall of prosthetic tube was slightly thicker and more inflexible. After this training, the surgical technique in real A3-A3 anastomosis was improved. CONCLUSIONS: This training system worked well to ease the transition from anastomosis in shallow surgical field to deep and narrow surgical field. The prosthetic tube we used approximates real A3 relatively well, and the ease in setting up this system enabled repeated practice, which resulted in steep learning curve of the technique.
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机译：背景：深部外科领域的脑血运重建在技术上具有挑战性。特别是，与端对端吻合相比，像A3-A3这样的对端吻合在技术上可能会更加困难。为了提高外科医生在深层外科领域的灵活性和可操作性，作者开发了一种易于使用且模拟良好的训练系统，该系统使用了人工导管和盒子。方法：将两根假肢管（直径为1.2毫米的硅管）平行安装在6.5厘米深的空纸巾盒的底部。盒子的孔口限制为2 x 2 cm，以模拟深而窄的手术通道。使用刺刀形的微型持针器和镊子，在手术显微镜下用10-0尼龙对管进行左右吻合。结果：假体管很好地模拟了真实的A3-A3吻合。从技术难度的角度来看，与实际的A3-A3吻合术相比，该训练系统需要更高的灵活性，这是因为手术通道更窄和更深，并且假体管的壁稍厚且更不易弯曲。经过培训后，真正的A3-A3吻合术的手术技术得到了改善。结论：该训练系统很好地缓解了从浅手术区的吻合向深窄手术区的过渡。我们使用的假肢管相对较好地逼近了真实的A3，并且该系统易于安装，可以反复练习，从而使该技术的学习曲线陡峭。
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