Use of a perfused cadaver for training of robotic pancreaticoduodenectomy allows for realistic tissue dissection and management of intra-operative bleeding

Abstract

Presenter: Britney Harris MD | West Virginia University, Morgantown Background: Minimally invasive pancreaticoduodenectomy (MIPD) has emerged as a promising alternative to open pancreaticoduodenectomy. However, the learning curve associated with mastering this complex operation is a significant hurdle for new programs and widespread implementation. Novel training modalities that realistically simulate MIPD are needed to provide for sufficient training without compromising patient safety. Perfused, fresh human cadavers (FHC) have been shown to be beneficial in surgical skills training. Herein, we aim to evaluate the use of perfused FHC as a training model for MIPD. Methods: The initial evaluation of the perfused FHC for MIPD included performing the resection portion of a robotic pancreaticoduodenectomy on the model in a standard operating room setting. The cadaver used was fresh, non-embalmed and never frozen. Vascular perfusion was achieved via cannulation of the femoral vessels and the use of a centrifugal pump with water-based blood substitute. Vascular perfusion was selectively utilized during the procedure to enhance vascular anatomy and simulate hemorrhage. Two surgical oncology faculty evaluated the perfused FHC model for tissue integrity as compared to live dissection as well as the ability to clearly demonstrate pertinent anatomy, including vascular structures. Additionally, the faculty assessed the pefused FHC ability to simulate a portal vein injury. Results: The resection portion of a robotic pancreaticoduodenectomy was successfully performed on a perfused FHC by two surgical oncology faculty. Both found the model to have high fidelity in regard to tissue integrity and dissection and to be highly realistic in the identification of pertinent anatomy, particularly vascular structures. Moreover, replicating the procedural steps was highly representative of the technical skills and troubleshooting required during robotic pancreaticoduodenectomy for both the console surgeon and bedside assistant. Similarly, the intentional portal vein injury allowed the operative surgeon to control the bleeding and repair the vessel, closely simulating one of the hazardous intra-operative complications of MIPD. Conclusion: Overcoming the learning curve of MIPD presents a challenge both for surgeons implementing MIPD programs and for clinical trials evaluating outcomes of MIPD compared with open surgery, as evident by recent randomized trials of MIPD plagued by unexpectedly high complication rates. Training programs incorporating virtual reality training and biotissue drills are useful, however these strategies do not simulate intra-operative experience and tissue handling. Perfused fresh cadavers offer an innovative approach to safe and effective MIPD training with highly realistic dissection and close recapitulation of the technical skills necessary to safely complete the procedure. Further studies are needed for the development and evaluation of this training method in MIPD and other complex procedures.