Students Learn Suturing Skills for Tiny Vascular Vessels
March 27, 2008
There’s the purse string, the parachute and the baseball – these are some of the suturing techniques UA surgery residents and medical students are practicing on small simulated blood vessels in a workshop offered by the Section of Vascular Surgery.
Considerable training is necessary to master vascular suturing and knot tying. Blood vessels are far less forgiving than other tissues commonly handled in general surgical practice. The vessel wall is made up of three layers, all of which are delicate and easy to traumatize. This is even more the case when the vessel is diseased. [M]
Historically, these specialized skills have been developed in the operating room, explains Luis R. León Jr., MD, RVT, assistant professor of clinical surgery and chief of vascular surgery at the Southern Arizona Veterans Affairs Health Care System. However, resident work-hour limitations, increasing costs of operating room time and patient safety concerns have led to an increased interest in teaching these skills in a simulated environment. In addition, the growing use of stents and other minimally invasive procedures for vascular conditions are providing little opportunity to perfect these skills when the need arises for open surgery.
The Vascular Surgery Workshop focuses on vascular suturing and knot-tying techniques, types of suture materials available and needle choices conducive to repairing vulnerable vessels, says Kay R. Goshima, MD, assistant professor of clinical surgery. The instruction incorporates lectures and hands-on practice using training boxes, suture and prosthetic graft material donated by several medical companies. Prosthetic grafts are mounted on a frame and cut in different shapes, simulating as close as possible real-life, human body conditions. Then the residents and students perform a vascular anastomosis, reconnecting the vessels, with end-to-end, end-to side anastomosis and interposition vein grafts. After the four-hour activity, which is held biannually on Saturdays, the participants and faculty discuss any remaining issues and propose suggestions to further improve the workshop.
Drs. Goshima and León organized the workshop, first for residents only, but after a couple of sessions decided that students in the Surgery Club could benefit from the training as well. Vascular surgery faculty Joseph Mills, MD, and Daniel Ihnat, MD, also serve as instructors.
For students, the workshop offers early exposure to a different surgical subspecialty that can help them decide which career direction to take in the future, says Dr. Goshima. Residents learn these vascular surgery techniques so when they show up for their scheduled rotation in our service, they are better prepared, Dr. León adds.