S. M. Wrenn1, S. R. Russell1, M. N. Barnett1, F. Hirashima1, C. E. Marroquin1 1University Of Vermont College Of Medicine / Fletcher Allen Health Care,The Robert Larner College Of Medicine,Burlington, VT, USA
Introduction: It is imperative that trainees obtain adequate surgical skills for independent practice. However, autonomy must be balanced with patient safety. Simulation has become a popular method of developing competency-based curriculums. Unfortunately, simulation often (whether cadaveric or synthetic) lacks the fidelity and realism of true operative tissue.
Methods: Solid abdominal and thoracic organs (heart, lung, kidney, pancreas, and liver) deemed unsuitable for transplantation were provided for simulation and research. Organs were kept fresh and then re-perfused using a roller pump-based perfusion circuit with pigmented blood substitute. Organs were sewn in-line to create a closed loop circuit. Residents and medical students participated in multiple workshops designed to improve surgical techniques, including transplant-based interventions. These educational sessions were led by attending surgeons from both cardiothoracic, abdominal organ transplant, and hepato-biliary services. Residents and medical students were queried on their perceptions of the workshop after completion via electronic survey.
Results:Multiple simulations were attended over a 12-month period. Skills performed included vena cava, portal vein and hepatic arterial anastomosis and dissection. Hepatic “re-animation” was followed by cholecystectomy, biliary dissection, and hepatic resection. Residents performed renal allograft anastomosis and vessel repair. Superior mesenteric and portal veins were sewn into a closed circuit and the “pancreatic tunnel” developed to allow division of the pancreatic neck. Finally, coronary artery bypass and aortic valve replacement was performed.
Of the 17 responding residents or students surveyed, 9 had participated in the workshops (22% medical students, 11% intern, 22% junior residents, and 44% senior residents). Participants rated the workshops as valuable and more realistic than traditional cadaveric or synthetic based simulation workshops. Respondents rated tissue fidelity and realism as 8 out of 10 (range, 6-9). 100% of participants reported that the simulations improved their operative skills, that they would attend further sessions, and that the sessions were a valuable use of the organs.
Conclusion: Use of fresh solid organs unfit for transplantation provides an opportunity for operative simulation of high fidelity and quality. There remains a large national opportunity to integrate these organs into surgical education. This proof of concept study demonstrates a novel means of creating realistic and reproducible surgical education for improvement in educational paradigms while allowing surgical educators to preserve the public trust by ensuring residents are ready to operate on living patients.
