38 (PB-038) Poster - Breast cancer axillary dissection a “lost procedure, sometimes still necessary…” how to prevent the lost of a surgical technique using cadaver body and Simlife

Abstract

Background: Sentinel lymphonodal biopsy (SLB) is nowadays regarded has a standard procedure in breast cancer surgical treatment. Moreover some authors are investigating the option to omit SLB in tumor less than two cm. On the other hand axillary dissection has become a “rare” indication for breast cancer surgery, thus decreasing surgeon performance and the possibility of learning this procedure among young surgeons. To utilize cadaver body for learning is a valuable tool for surgery competence acquisition. Sim- life is a patented device helping cadaver body utilization for learning process. Material and methods: We analyze the ideal steps to learn axillary dissection, for young breast cancer surgeon throughout an individual experience of a trainee. The doctor attended the fourth year specialization school in Gynecology, with a dedicated time (8 months) at the breast cancer treatment at the University of Turin (Breast cancer Unit around 1000 cases per yr). The learning process developed throughout five steps for eight months duration: the first at the master of senology helping teacher in preparing anatomical lesson. The second as assistant in 20 surgical breast cancer procedures. The third as first operator in 20 breast cancer surgical procedures including SLB and starting with treating the axilla (axillary dissection) in a gradual manner. The fourth phase included a cadaver-lab course at University center of Poitier together with the senior tutor for two days, utilizing Sim- life patented device (revitalized cadaver system) and performing 4 complete axillary dissections (both sides per cadaver). In the fifth step the trainee performed two axillary dissections on patients under senior tutor assistance. The trainee had to fill a form developed to describe time of different surgical procedures, surgical difficulties and competences acquisition. Results: Both timing criteria and surgical items increases during the training period of 8 months with a decrease in time performing SLB of 50% (p = 0.005) and increase of more than 80% (p = 0.04) in competence acquisition in identifying anatomical structures during axillary dissection procedure in a statistically significant manner. Trainee self- confidence was also increased together with satisfaction even from a psychological point of view (data registered with a questionnaire). Conclusions: Programmed learning/tutoring process through pre-defined steps, in association with cadaver-lab, Sim-life device and hands-on practice improve surgical competences acquisition permitting practice also surgery that nowadays remains necessary, even though more rarely than in the past according to clinical indications, such as axillary dissection. No conflict of interest.