Surgical Education
Perfused fresh cadavers: method for application to surgical simulation

https://doi.org/10.1016/j.amjsurg.2014.10.027Get rights and content

Abstract

Background

Cadaveric dissection is the gold standard for surgical simulation because it demonstrates authentic anatomy and tissue handling. We present a perfusion technique that restores blood flow and pressure in the fresh human cadaveric model.

Methods

The femoral vessels were cannulated and perfused using a vortex centrifugal pump and a novel perfusate. The trachea was intubated and mechanically ventilated. Tissue perfusion was evaluated by direct inspection, intravascular pressure monitoring, and indocyanine green angiography. A cost analysis and survey results for 969 trainees is presented.

Results

A mean arterial pressure of 80 mm Hg and venous pressure of 15 mm Hg were established, resulting in dermal and microvascular perfusion. Successful pulmonary ventilation was achieved. This model has been applied to 122 cadaveric specimens over 12 months in a variety of surgical subspecialties and training levels. Total cost for establishing the perfused model was $1,262.55. Trainee confidence after use of the model increased from 2.85 to 4.20 (P < .00).

Conclusions

Perfusion of fresh cadavers replicates human tissue handling, vascular anatomy, and dissection. The perfused human cadaver increases the authenticity of surgical simulation and is applicable to procedure-based specialties.

Section snippets

Logistics

The Fresh Tissue Dissection Laboratory at the University of Southern California was established as a multidisciplinary educational program to allow physicians and medical students access to fresh tissue specimens for the purposes of anatomic and procedural teaching. The standard operating procedures were established and approved by the institutional review board in 2005 and revised in 2012. Procurement of all cadavers occurs according to the standard operating procedures and follows strict

Establishment of arterial pressure

On infusion into the femoral artery, pressures were measured as a function of the rate of infusion via the centrifugal pump. Arterial pressure was controllable and could be established from 0 to 200 mm Hg (Fig. 4). Brisk bleeding from large vessels on arteriotomy was encountered at blood pressures higher than 40 mm Hg. Successful capillary bleeding at the skin level was verified by skin incision and was repeatable at pressures higher than 90 mm Hg. In addition, skin color changes are noted at

Comments

The successful establishment of cadaveric circulation was described by Garrett18 in 2001 in an attempt to create a model for the evaluation of vascular devices and for the simulation of vascular surgical procedures. The abstract on the patented method describes its purpose, “for study of vascular function, research and teaching of surgical procedures and general medical education.” Garrett's18 model is the first reported attempt to create a surgical simulation model using vascular

Conclusion

The use of pressurization techniques in the cadaver increases educational value of the fresh human cadaver as education resource.

References (23)

  • J.R. Sadaba et al.

    Does the introduction of duty-hour restriction in the United States negatively affect the operative volume of surgical trainees?

    Interact Cardiovasc Thorac Surg

    (2011)

    • Cited by (0)

    The authors declare no conflicts of interest.

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