Stepwise approach for acquisition of microsurgical skills through rat orthotopic liver transplantation experiments.

Although rat liver transplantation (LT) is useful in training surgeons to perform microsurgery, mastering these surgical techniques remains difficult. Systematized training protocols are needed that enable learning of the proper skills in a short period of time. The present study describes an efficient five-step rat LT training protocol for surgeons designed to be mastered within 3 months through continuous training. The first step was to review all procedures by watching full videos of rat LT and to watch actual LT operations performed by a skilled surgeon, enabling recognition of the anatomy of rat abdominal organs. The second step was to perform ten donor operations, including ex-vivo graft preparation, to learn the atraumatic and delicate techniques. The third step was to perform ten LTs, with the goal of achieving an anhepatic time < 20 min and surviving until the next day. The fourth step was to perform ten additional LTs, with the goal of achieving 7 day survival. The fifth step was to perform 5-10 more LTs, with the goal of achieving 7 day survival in five consecutive LT operations. Systematizing the training was found to increases its efficiency. Furthermore, determining the specific number of operations in advance is useful to maintain motivation for training. Mastering efficient rat LT will not only enhance the success of preclinical research, but will enable young surgeons to better perform vascular anastomoses under a microscope in humans.