Central Microsurgical Unit
Final Report Abstract
We successfully trained young fellows in a variety of microsurgical techniques eventually leading the most talented ones to master rat liver transplantation following our newly developed training concept. Training was divided into 4 phases: Pre-training phase, Basic-microsurgical-training phase, Advancedmicrosurgical-training phase, and Expert-microsurgical-training-phase. Two “Productivity-phases” were introduced right after the Basic- and Advanced-microsurgical-training-phases. The "productivity phases" allowed the trainee to accumulate experience and become scientifically productive before proceeding to a more complex procedure. We used the PDCA-concept and established quality criteria to control the learning-process and the surgical quality. Predefined quality-criteria included survival rate, intra-operative, post-operative and histological parameters. The stepwise and PDCA-based training program increased the efficiency of LTx training, whereas the constant application and development of predefined quality-criteria guaranteed the quality of microsurgery. During this process we further refined the surgical techniques and improved experimental conditions. During this process, we also identified a molecular marker of manipulation injury. We observed that translocation and release of danger signals such as HMGB1 occurred in response to classic ischemic injury induced by clamping a vessel and in response to ischemic injury induced by applying pressure to the liver parenchyma. Interestingly, translocation did not occur in response to isolated hyperperfusion injury as induced by a technically perfect partial hepatectomy. This observation does suggest to use translocation of HMGB1 as indicator of pressure-related mechanical injury. An ongoing analysis confirmed that translocation was observed after partial hepatectomy, when the procedure was performed by a beginner, exerting too much pressure on the hepatic parenchyma during surgical manipulation.
Publications
- Intraoperative vital and haemodynamic monitoring using an integrated multiple-channel monitor in rats. Lab Anim 2010, 44: 254-263
Huang H, Deng M, Jin H, Dirsch O, Dahmen U
(See online at https://doi.org/10.1258%2Fla.2009.009055) - Release of danger signals during ischemic storage of the liver: a potential marker of organ damage? Mediators Inflamm 2010, 2010: 436145
Liu A, Jin H, Dirsch O, Deng M, Huang H, Bröcker-Preuss M, Dahmen U
(See online at https://doi.org/10.1155/2010/436145) - A novel end-to-side anastomosis technique for hepatic rearterialization in rat orthotopic liver transplantation to accommodate size mismatches between vessels. Eur Surg Res 2011, 47: 53-62
Huang H, Deng M, Jin H, Liu A, Dirsch O, Dahmen U
(See online at https://doi.org/10.1159/000324905) - HMGB1 translocation and expression is caused by warm ischemia reperfusion injury, but not by partial hepatectomy in rats. Exp Mol Pathol 2011, 91: 502-508
Liu A, Dirsch O, Fang H, Dong W, Jin H, Huang H, Sun J, Dahmen U
(See online at https://doi.org/10.1016/j.yexmp.2011.05.005) - (2012): Preliminary experience of a PDCA-cycle and quality management based training curriculum for rat liver transplantation. In: The Journal of surgical research 176 (2), S. 409–422
Jin H, Huang H, Dong W, Sun J, Liu A, Deng M, Dirsch O, Dahmen U
(See online at https://doi.org/10.1016/j.jss.2011.10.010)
