Validation of novel microsurgical vessel anastomosis techniques: A systematic review.

INTRODUCTION: Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques.

METHODS: A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects.

RESULTS: The literature search yielded 6,658 articles. 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, nine studies validated novel modified interrupted suture techniques, six studies modified continuous techniques, six studies modified sleeve anastomosis techniques, one study a modified vesselotomy technique, seven studies sutureless techniques, and one study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals (n=1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects (n=29). Statistical power-analysis and confounder adjustment were performed in one animal study. Out of eighteen non-comparative studies, five studies validated novel modified interrupted suture techniques, one study a modified continuous technique, two studies modified sleeve anastomosis techniques, four studies modified vesselotomy techniques, four studies sutureless techniques, and two studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects (n=320), with two RCTs. Eight studies contained human subjects (n=173). Statistical power-analysis and confounder adjustment were performed in none of the animal or human studies.

CONCLUSION: The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power-analysis should be performed as a standard method of novel technique validation.