Training Surgeons With Organs Unfit To Transplant
*Adam Petchers1, *Sheila Russell1, *Fuyuki Hirashima2, Mitchell Norotsky2, Carlos Marroquin2
1University of Vermont, Burlington, VT;2University of Vermont Medical Center, Burlington, VT
1. Objective: Our goal is to create a novel surgical simulation model using donor organs rejected for transplantation. This will allow training programs to improve surgical resident comfort and performance in complex open surgeries. 2. Design: Proof of concept study demonstrating feasibility, reproducibility and use of a novel surgical simulation model. 3. Setting: The University of Vermont General Surgery Residency Training Program. 4. Participants: Recovered organs deemed unfit for transplant are donated by local Organ Procurement Organizations. Surgical residents and attending surgeons participate in the simulation. 5. Intervention: Un-transplantable allografts are sewn in-line with roller pumps to major vessels, creating a closed circuit. They are perfused with a pigmented blood substitute, and surgical procedures are performed. Simulations are also performed on fixed and fresh/frozen cadavers under similar operative conditions for comparison. 6. Main Outcome Measures: We assessed the visual and haptic fidelity and application of surgical exercises and technical skills. 7. Results: We found the simulation to have realistic anatomic landmarks, appearance, texture, and vascular flow. The simulation of blood pressure, tissue perfusion, and bleeding during injury provides an ideal environment for development of technical skills with no risk to living patients. This was superior to either cadaver model tested. Residents performed tissue and vascular dissection, mobilization of structures, vessel repair and ligation, surgical injury repair, and vascular anastomosis using standard open surgical techniques with appropriate tissue response. 8. Conclusion: Utilizing organs unfit for transplantation allows near-realistic operative experience and an optimal paradigm to prepare trainees for challenging operative cases. This proposed simulation optimizes surgical training while preserving the public trust that surgical trainees are prepared in advance of operating on living patients.
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