Cadaver Lab Research Articles

MINARO DRS: usability study of a robotic-assisted laminectomy

Abstract Purpose Although the literature shows that robotic assistance can support the surgeon, robotic systems are not widely spread in clinics. They often incorporate large robotic arms adopted from the manufacturing industry, imposing safety hazards when in contact with the patient or surgical staff. We approached this limitation with a modular dual robot consisting of an ultra-lightweight carrier robot for rough prepositioning and small, highly dynamic, application-specific, interchangeable tooling robots. Methods A formative usability study with N = 10 neurosurgeons was conducted using a prototype of a novel tooling robot for laminectomy to evaluate the system’s usability. The participants were asked to perform three experiments using the robotic system: (1) prepositioning with the carrier robot and milling into (2) a block phantom as well as (3) a spine model. Results All neurosurgeons could perform a simulated laminectomy on a spine phantom using the robotic system. On average, they rated the usability of this first prototype already between good and excellent (SUS-Score above 75%). Eight out of the ten participants preferred robotic-assisted milling over manual milling. For prepositioning, the developed haptic guidance showed significantly higher effectiveness and efficiency than visual navigation. Conclusion The proposed dual robot system showed the potential to increase safety in the operating room because of the synergistic hands-on control and the ultra-lightweight design of the carrier robot. The modular design allows for easy adaptation to various surgical procedures. However, improvements are needed in the ergonomics of the tooling robot and the complexity of the virtual fixtures. The cooperative dual robot system can subsequently be tested in a cadaver laboratory and in vivo on animals.

Rhinoplasty Training: An Innovative Learning Approach Using Chicken Breast.

Mastering rhinoplasty surgical techniques requires extensive learning involving theoretical studies, internships, cadaver laboratories, simulators, nonhuman models, and hands-on practice. A novel method using chicken breast simplifies skill development, offering flexibility and accessibility. Training on chicken breast allows surgeons to refine skills through various techniques and grafts. This study focuses on preservation techniques using chicken as a model. Surgical sequences simulate nasal structures using prepared chicken breasts. Documentation through media illustrates procedures from basic to advanced, using materials akin to traditional rhinoplasty but in reduced quantities. Chicken breast tissue, especially sternal cartilage, offers a suitable substrate for practicing techniques and grafting without live human or cadaveric tissue. This method provides an efficient, safe, and cost-effective approach to learning rhinoplasty.

Lessons learned from the Sexual Medicine Society of North America fellowship bootcamp.

Sexual Medicine Society of North America (SMSNA) fellowships offer variable experience in sexual health domains: erectile dysfunction, Peyronie's disease, male infertility, male hypogonadism (low testosterone), reconstruction (including male incontinence), benign prostatic hyperplasia, gender affirmation surgery, sexual mental health, and female sexual dysfunction. To evaluate baseline and postbootcamp understanding and trust in these domains. In 2023, 28 of 31 urologists currently enrolled in SMSNA-endorsed fellowships participated in a 3.5-day training bootcamp in Minneapolis, Minnesota. Participants were asked to complete pre- and postbootcamp surveys. The bootcamp curriculum offered American Urological Association guidelines and case-based lectures, hands-on clinical training with cadavers (penile surgery) and models (collagenase training), and interaction with industry. Changes in knowledge, independence, and trust in performing the procedures, as well as billing issues and feedback for future bootcamps. Prebootcamp surveys revealed vastly varied residency experience. Reported time with an expert faculty member was greatest for benign prostatic hyperplasia and least for female sexual dysfunction, gender affirmation surgery, and low testosterone. The lowest prebootcamp confidence in performing surgery independently was for penile grafting procedures and elevating the neurovascular bundle. Postbootcamp results revealed several areas of significant improvement in confidence (P ≤ .03): intralesional injections for Peyronie's disease, manual modeling, penile plication, penile grafting procedures, and elevating the neurovascular bundle. There was a trend for improved confidence with the insertion of inflatable (P = .05) and semirigid (P = .08) penile prostheses. Nonsignificant improvement occurred in artificial urinary sphincter surgery (P = .12). Participants graded the bootcamp very highly and requested that next year's bootcamp have more content on female sexual dysfunction, male incontinence, and low testosterone, as well as more hands-on skills sessions and case-based lecture formats. Offering a bootcamp with hands-on instruction could significantly improve urologists' knowledge and confidence. As the main strength, this study was the first specialized bootcamp for urologists in the subject of men's health, taking into account hands-on and cadaver laboratories, as well as highlighting industrial and pharmaceutical products. The small sample size was the major limitation. Current SMSNA fellows present with varied levels of experience and confidence across sexual health domains. Notable confidence improvements were seen with topics that combined didactic lectures with hands-on trainings.

Enhancing Cadaver Labs for Endoscopic Spine Surgery: The Glove as the “Lesion”

We describe a novel yet simple training exercise for residents who are being introduced to endoscopic spine surgery. Prior to residents training on the endoscopic interlaminar approach, the course faculty performed an endoscopic transforaminal approach and inserted a small piece of a surgical glove into the ventral epidural space of a cadaveric torso. The transforaminal approach did not alter the anatomy of the interlaminar approach so the residents were able to practice as if it were a de novo situation. Placing the small "lesion" provided an exercise to confirm the residents were able to safely access the area and provided practice for them to carefully grasp the "lesion" and remove it. Prior to resident training on the endoscopic transforaminal approach, the course faculty utilized an interlaminar approach to place the "lesion". A questionnaire with a five-point Likert scale of agreement was completed by the residents to assess their experience with the training exercise. Five residents attended the cadaver lab, and 100% strongly agreed that the cadaver lab provided a realistic representation of the procedure demonstrated, the "lesion" removal added to their educational experience, and they were overall satisfied with the educational session. One of the lessons learned with this exercise that we will consider in future courses would be to place a radiodense "lesion" that could be visualized on fluoroscopy, and serve as a radiologic target to find. This can help guide the trainee in knowing where to search if the "lesion" is more difficult to find.

Assessment of High-fidelity Anatomical Models for Performing Pterional Approach: A Practical Clinic in American Association of Neurological Surgeons Meeting 2024

Over the last decade, simulation models have been increasingly applied as an adjunct for surgical training in neurosurgery. We aim through a practical course at a national neurosurgical conference to evaluate 3D non-cadaveric simulation models along with augmented reality for learning and practicing the pterional craniotomy approach among a wide variety of participants including medical students, neurosurgery residents, and attending neurosurgeons. Our course was conducted during an international neurosurgery meeting with 93 participants but the course surveys (pre- and post-course) were completed by 42 participants. Most participants were medical students (31; 73.8%). Participants with no experience (the majority) in cadaver lab dissections, craniotomy as first operator, and as second operator represented 12 (27.9%), 29 (69%), and 22 (52.4%), respectively. Participants with moderate experience in cadaver lab dissections were 23 (53.5%). Post-course survey respondents noted positive feedback in most items queried including enhancement of familiarity and acquiring skills, confidence with neurosurgery instruments, confidence with microscope, part of standard training, traditional training, and lifelong training. Simulation model combining augmented reality with physical simulation for hybrid experience can be a promising and valuable tool especially for medical students or early career neurosurgical residents.

Comparative Analysis of Multidimensional Learning Tools in Anatomy: A Randomized Control Trial.

Anatomy teaching has traditionally been based on dissection. However, reduced hours in total and laboratory hours in gross anatomy along with a dearth of cadavers have ensued the search for a less time-consuming tool. The study was conducted in the Department of Anatomy in Sheikh Bhikhari Medical College, Hazaribag. A total of 282 medical students were taught gross anatomy, using three different learning modalities: dissection (n = 95), plastic models (n = 94), and three-dimensional (3D) anatomy software (n = 93). The knowledge of the students was examined by 100 multiple-choice question (MCQ) and tag questions followed by an evaluation questionnaire. When performance is considered, the dissection and 3D group performed better than the plastic models group in total, MCQs, and tag questions. In the evaluation questionnaire, dissection performed better than the other two modalities. Moreover, dissection and 3D software emerged as superior to the plastic models group. All data were analyzed using the one-way ANOVA and t-test. Group-based analysis by ANOVA and gender-based analysis were done by Student's t-test. A comparison of students' perceptions was done by Kruskal-Wallis H-test. Dissection remains a favorite with students and accomplishes a significantly higher attainment of knowledge. Plastic models are less effective but are a valuable tool in preparation for cadaveric laboratories.

Procedures Group Chat: A Resident-Driven Approach to Increase Procedural Competency

Introduction: In 2007, the American Board of Internal Medicine (ABIM) shifted away from requiring completion of procedures during residency training and towards emphasizing common procedural indications, contraindications, and complications. As a result, many procedures are now referred to consulting services such as critical care and interventional radiology (IR). Our aim was to address this training gap through a resident-driven initiative that provided daily opportunities to collaborate on procedures in a supervised clinical setting. Methodology: In January 2023, we created a secure group chat and invited Internal Medicine (IM) residents to voluntarily join if they were interested in learning or teaching bedside procedures such as thoracenteses, paracenteses, lumbar punctures, and line placement. Residents who identified a need for a non-emergent bedside procedure would reach out in the group chat to see if a resident certified to perform and supervise that procedure would be available and could subsequently coordinate availability. A two-question survey was sent to the entire residency program asking residents whether they were a part of the group chat and whether they found the chat helpful in advancing their medical knowledge. The impact of the initiative was measured through procedures logged in to New Innovations, a website used by graduate medical education to log completed procedures. We chose five procedures (paracenteses, thoracenteses, central lines, arterial lines, and lumbar punctures) to compare changes in procedure volume performed by IM residents one year before and after the group chat was set up. Results: 64 out of 108 residents responded to the survey (59% response rate). 90% of respondents stated that they were part of the group chat and 76.6% responded they “agree/strongly agree” that the procedures group chat has been helpful. Objective measures of the group chat’s impact revealed a 93% increase in the number of procedures performed by residents. IM Residents logged 122 procedures in 2022, the year prior to the initiation of the group chat, compared to 235 procedures logged in 2023, the year after. There was a 96% increase in paracentesis and 387% change in thoracenteses completed after the group chat was established. Conclusions: The procedures group chat nearly doubled the number of procedures completed and logged by residents. This group chat has fostered enthusiasm for patient care by helping us overcome some of the barriers and delays in health care due to factors out of our control, such as limited resources or staffing. Due to the inexpensive nature of this initiative, it can be easily replicated at other IM programs across the country, especially those without resources such as simulation centers. Future goals include creating formal teaching sessions including cadaver lab simulations and a proceduralist elective for procedures to be taught and supervised by certified residents, attendings, and subspeciality services for a multidisciplinary education.

Ankle impingement after extra-articular open fracture of the leg: Full arthroscopic treatment in the supine position

ObjectiveExtra-articular open fractures of the leg often result from high energy trauma. After healing, a painful ankle impingement may occur. In the event of anterior and posterior impingements, arthroscopic treatment may require two surgical positions. We propose an operative strategy to treat anterior and posterior ankle impingement after extra-articular open fracture of the leg. Our hypothesis is that this strategy is simple, effective and with a low risk of complication. Material and methodAnterior ankle impingements were treated by anterior arthroscopy in supine position; anterior and posterior impingements were treated by anterior and posterior arthroscopy in supine position; anterior and posterior impingements associated with retraction of gastrocnemius muscles were treated with anterior arthroscopy in supine position followed by posterior arthroscopy in prone position, and an open tendon lengthening of the calcaneal tendon in the same position. The anterior and posterior arthroscopic release was tested in the cadaver laboratory. Then, the surgical strategy was applied to our patients in our clinical practice. After, we analysed retrospectively the results of the strategy in the first patients treated for a painful ankle impingement after extra-articular open fracture of the leg. The data retrieved were the importance of pain (VAS), the presence of clinical instability, ankle mobility, gastrocnemius retraction and the AOFAS functional score and the post-operative complications. Then, these data were compared before the surgery and at last follow-up. ResultsFrom the cadaver laboratory, anterior and posterior arthroscopic release was possible in all cases without changing position. From our clinical practice, we included 5 patients (3 women and 2 men, mean age 43 years) suffering from an ankle impingement after extra-articular open fracture of the leg (2 patients with isolated anterior impingement, 1 patient with anterior and posterior impingement, and 2 patients with anterior and posterior impingement plus a gastrocnemius retraction). All post-operative parameters (pain, range of motion and AOFAS score) at mean follow-up of 53 months were improved. No post-operative complication was reported. ConclusionWe propose a surgical strategy adapted to the different clinical presentations of ankle impingement after extra-articular open fracture of the leg.

The Eyelid Trans-orbital Trans-cavernous Approach to the Basilar Apex: A Cadaveric Proof-of-Concept Study

Abstract Objective The pretemporal transcavernous approach is an elegant technique that provides exposure to the basilar apex, which is conventionally completed with a frontotemporal incision. This can also be performed via a minimally invasive eyelid transorbital approach, which has unique attributes. This is a proof-of-concept cadaveric study to demonstrate details of the combination of these two approaches. Design This study is a proof-of-concept study using cadaveric heads. Setting This study is a proof-of-concept study in a cadaveric laboratory. Participants A latex-injected cadaveric head. Main Outcome Measures Detailed dissection was performed and demonstrated in a step-by-step fashion. Results The eyelid transorbital approach provides the exact exposure required to complete the pretemporal osteotomy including an anterior clinoidectomy and dissection, so that a transcavernous approach can be completed. The basilar apex and its branches can also be accessed via the eyelid transorbital approach, with comparable exposure to the traditional approach; however, the access trajectory is much narrower. It takes advantages of the inferior corridor with a more medial access angle and provides a complementary perspective to the cavernous sinus contents and basilar apex complex. Conclusion The combination of an eyelid transorbital and pretemporal transcavernous approaches can achieve a deep exposure via a minimally invasive incision, which may add an additional approach to the cavernous sinus and basilar apex regions.

First report of robotic retromuscular incisional hernia repair with Hugo Ras™ surgical system.

Treatment of incisional hernia is a rapidly evolving field of surgery, with actual trends being oriented toward retromuscular/preperitoneal mesh placement. The diffusion of robotic surgery is constantly growing in different surgical specialties and is gaining widespread acceptance for abdominal wall reconstruction. Recently, novel robotic platforms have entered into the market. In this study, we present the first transabdominal retromuscular incisional hernia repair performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed an official 2-day session running incisional hernia repair on human cadaver lab. Operating room setting and trocar layout were planned. The patient presented a 4 × 4cm midline incisional hernia and was scheduled for transabdominal retromuscular incisional hernia repair at our Institution. A description of the operative room setup, robotic arm configuration and docking/tilt angles is provided. Docking time, operative time, and console time were 15, 95, and 75min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversion to open surgery was recorded. Postoperative course was uneventful and the patient was discharged on postoperative day 2. The safety and the feasibility of these procedures will require further analysis and larger patients' sample sizes for procedural standardization and potential integration into minimally invasive abdominal wall reconstruction programs.

The Safety of Volar to Dorsal Percutaneous Screw Fixation of Bennett Fracture-Dislocation - A Cadaveric Study.

Background: Bennett fractures are traditionally fixed with percutaneous K-wires from dorsal to volar, or with a volar to dorsal screw via a volar open approach. While volar to dorsal screw fixation is biomechanically advantageous, an open approach requires extensive soft tissue dissection, thus increasing morbidity. This study aims to investigate the practicality and safety of Bennett fracture fixation using a percutaneous, volar to dorsal screw, particularly with regard to the median nerve and its motor branch during wire and screw insertion. Methods: Fifteen fresh frozen forearm and hand specimens were obtained from the University of Auckland human cadaver laboratory. A guidewire is placed under image intensifier from volar to dorsal with the thumb held in traction, abduction and pronation. The wire is passed through the skin volarly under image intensifier, then the median nerve is dissected from the carpal tunnel and the motor branch of the median nerve (MBMN) is dissected from its origin to where it supplies the thenar musculature. The distance between the K-wire to the MBMN is measured. Results: In 14 of 15 specimens, the wire was superficial and radial to the carpal tunnel. The mean distance to the origin of the MBMN is 6.2 mm (95% CI 4.1-8.3) with the closest specimen 1 mm away. The mean closest distance the wire gets to any part of the MBMN is 3.7 mm (95% CI 1.6-5.8); in two specimens, the wire was through the MBMN. Conclusions: Wire placement, although done under image intensifier, is subject to significant variation in exiting location. While research has shown the thenar portal in arthroscopic thumb surgery is safe, our guidewire needs to exit further ulnar to capture the Bennett fracture fragment, placing the MBMN at risk. This cadaveric study has demonstrated the proposed technique is unsafe for use.

Enhancing Gross Anatomy Courses in Occupational Therapy with 3D Applications: An Assessment of Effectiveness

Traditional teaching methods, such as two-dimensional PowerPoint presentations, are prevalent in anatomy education but must provide an in-depth perception of anatomical structures. This article discusses integrating 3D anatomy application in an Occupational Therapy course as an advanced technique for anatomical learning. The "Complete 3D Anatomy" app was employed to facilitate the teaching of anatomy structures. Students from 2 different cohorts, 93 from 2022 and 96 from 2023 test scores, were considered in this endeavor. The 2022 group used the 3-D app on their own time, compared to the 2023 group, who were required to use it in class for every lecture by the instructor. Results showed improvement in their test score from 71% (2022) to 87% (2023), with the integration of the 3-D as a class activity. Based on these results, it is concluded that the 3D anatomy app is an essential tool for comprehensive anatomical learning. For future courses, there is a plan to integrate further and assess the benefits of requiring students to employ a tablet or iPad equipped with 3D apps, along with a virtual dissection table to complement teaching and learning enterprises in the human cadaver laboratory.

The 2-by-2 Inch “Key Window” in the Upper Extremity: An Anatomical Appraisal of the Accessibility and Proximity of the Major Nerves and Vessels

The brachial plexus is a network of nerves located between the neck and axilla, which receives input from C5-T1. Distally, the nerves and blood vessels that supply the arm and forearm form a medial neurovascular bundle. The purpose of this study was to illustrate that a peripheral nerve dissection via a 2×2 inch window would allow for identification and isolation of the major nerves and blood vessels that supply the arm and forearm. A right side formalin-fixed latex-injected cadaveric arm was transected at the proximal part of the axillary fold and included the scapular attachments. Step-by-step anatomical dissection was carried out and documented with three-dimensional digital imaging. A 2×2 inch window centered 2 inches distal to the axillary fold on the medial surface of the arm enabled access to the major neurovascular structures of the arm and forearm: the median nerve, ulnar nerve, medial antebrachial cutaneous nerve, radial nerve and triceps motor branches, musculocutaneous nerve and its biceps and brachialis branches and lateral antebrachial cutaneous nerve, basilic vein and brachial artery and vein, and profunda brachii artery. Our study demonstrates that the majority of the neurovascular supply in the arm and forearm can be accessed through a 2×2 inch area in the medial arm. Although this "key window" may not be entirely utilized in the operative setting, our comprehensive didactic description of peripheral nerve dissection in the cadaver laboratory can help in safer identification of complex anatomy encountered during surgical procedures.

Moving Beyond the Temporal Bone Lab: Creating a Drilling Station in the Otolaryngology Clinic.

With the advent of operable 3-dimensional (3D)-printed models, case preparation could occur outside of the cadaveric laboratory. The objective of this study was to design a mobile drilling station that can be used for surgical practice in a variety of clean workplaces. Using materials obtained from hardware stores and online retailers, a wheelable drilling station was constructed to mimic laboratory conditions while also being easily maneuverable into clinic rooms. The station houses the otologic drill, suction, and irrigation mechanisms, is height adjustable, and has a shielded workspace. The mobile drilling station was moved into a microscope-containing otolaryngology clinic room where faculty and trainees were asked to drill a pediatric 3D-printed temporal bone followed by completing an evaluation survey. This is the first mobile drilling station described in the literature and can be easily constructed, mobilized, and used in an otolaryngology clinic for dedicated surgical practice using 3D-printed models.

Ultrasound guided quadro-iliac plane block: another novel fascial plane block.

We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. A cadaveric examination that evaluates the spread of QIP block. Cadaver laboratory. One unembalmed cadaver. Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. Dye spread in cadaver. There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread.Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.

The use of an online anatomy laboratory for allied health education

BackgroundIn-person cadaveric anatomy laboratories allow for students to learn the intricacies of the human body but also develop skills related to communication, clinical reasoning, and interprofessional collaboration. However, the COVID-19 pandemic caused a shift from in-person course delivery to an online medium. Therefore, the objective of this study was to develop and evaluate the implementation and use of an online anatomy laboratory as a replacement for an in-person laboratory component. MethodsAn anatomy course for allied heath students (pharmacy and respiratory therapy) that included an in-person cadaveric laboratory was modified for online delivery. The laboratory component utilized cadaveric images presented by the instructor and breakout rooms for small group discussion to simulate in-person anatomy laboratory experiences. ResultsOnline anatomical studies had no academic advantage or disadvantage compared to in-person instruction. Additionally, students indicated that the online laboratories were enjoyable and helpful for learning anatomy, rated the guided cadaveric image portion very highly and responded positively to the helpfulness of breakout room sessions in learning anatomy. ConclusionsBased on the results of this study, online delivery of an anatomy laboratory, that was developed to simulate important aspects of in-person learning, can act as a viable alternative-learning platform for anatomical laboratory education.

Ultrasound Incorporation in Gross Anatomy Labs in a Master of Medical Sciences Program: A Mixed-Methods Analysis of Student Performance and Perception.

Teaching ultrasound imaging is on the rise in undergraduate medical anatomy education. However, there is little research exploring the use of ultrasound in preparatory graduate programs. The purpose of this study is to identify the effects of ultrasound imaging inclusion in a graduate gross anatomy course. Master of Medical Sciences students were enrolled in a prosection-based anatomy course that included pinned cadaver stations and an ultrasound station. Using ultrasound, teaching assistants imaged volunteers demonstrating anatomical structures students previously learned at cadaver stations. Students answered one ultrasound image question on each practical exam and were asked to participate in a pre- and post-course survey. Student practical and lecture exam scores and final course grades from the 2022 cohort were compared to a historical control cohort from 2021 via statistical analysis, including a survey administered to the 2022 cohort. Two hundred students from the 2021 cohort and 164 students from the 2022 cohort participated in this study. Students in the 2022 cohort had significantly higher scores in 1 of the 5 practical exams (P < .05, d = .289), and 2 of the 5 written exams (P < .05, d = .207), (P < .05, d = .311). Survey data revealed increased (P < .05, d = 1.203) learning outcome achievement from pre-survey to post-survey in the intervention cohort. Students who correctly answered the ultrasound question performed significantly better on practical's 3 (P < .05) and 4 (P < .05) than those who missed the ultrasound question. These findings suggest that ultrasound imaging in a cadaver lab is beneficial to graduate students' learning and understanding of gross anatomy.

Meralgia Paresthetica-An Approach Specific Neurological Complication in Patients Undergoing DAA Total Hip Replacement: Anatomical and Clinical Considerations.

Introduction: Mini-invasive surgical (MIS) approaches to total hip replacement (THR) are becoming more popular and increasingly adapted into practice. THR via the direct anterior approach (MIS DAA) has become a rather controversial topic in hip arthroplasty literature in the last decades. Our retrospective observational study focuses on the prevalence of one approach-specific complication-lateral femoral cutaneous nerve (LFCN) iatrogenic lesion-and tries to clarify the possible pathogenesis of this injury. Methods: This is a retrospective single-cohort observational single-center and single-surgeon study. Our patient records were searched for the period from 2015 to 2017-after a safe period of time after the learning curve for MIS DAA. All intra- and post-operative lesions of the LFCN were recorded. Lesion of the LFCN was confirmed by a neurological examination. Minimum patient follow-up was 2 years. Results: This study involved 417 patients undergoing single-side THR via MIS DAA. Patients were examined on follow-up visits at 6 weeks, 6 months, 1 year, and 2 years after surgery. There were 17 cases of LCFN injury at the 6 weeks early follow-up visit (4.1%). All cases of clinically presenting LFCN injury resolved at the 2-year follow-up ad integrum. Discussion: Possible explanations of such neurological complications are direct iatrogenic injury, vigorous traction, hyperextension, or extreme external rotation of the operated limb. Use of a traction table or concomitant spinal pathology and deformity also play a role. Prevention involves stepwise adaptation of the approach during the learning curve period by attending cadaver lab courses, rational use of traction and hyperextension, and careful surgical technique in the superficial and deep fascial layers. Dynamometers could be used to visualise the limits of manipulation of the operated limb. Conclusions: Neurological complications are not as rare but questionably significant in patients undergoing THR via the DAA. Incidental finding of LFCN injury has no effect on the functional outcome of the artificial joint. It can lead to lower subjective satisfaction of patients with the operation, which can be avoided with careful education and management of expectations of the patients.

3D printed headholder for use in neurosurgical cadaver training: Technical note

IntroductionHeadholders or skull clamps serve as indispensable tools in neurosurgery, facilitating the precise positioning and stabilization of the head for surgery. The realm of neurosurgical training in cadaver labs presents a clear challenge due to the lack of suitable non-clinical headholders. Research questionWe describe a 3D printed stainless-steel headholder for use in neurosurgical cadaver lab training. Material and methodsComputer-aided design software was used to design a headholder, utilizing a three-pin skull fixation. Through an iterative process involving a plastic 3D printed prototype, ultimately a robust model was manufactured using a 3D stainless-steel printer. ResultsThe headholder was fixed to a multi-angle adjustable vise, enabling optimal positioning to support simulation of neurosurgical approaches and dissection training by neurosurgical residents and staff in the cadaver lab. Discussion and conclusionThis custom-made headholder offers an effective solution for secure fixation of cadaver skulls during neurosurgical training, contributing to practicality and efficiency in cadaver dissection. Despite the lack of evidence-based guidelines for neurosurgical headholder use, this device provides a valuable tool for neurosurgical trainees to practice proper placement, understand associated complications, and improve their hands-on skills. The digitally available 3D model can be optimized, shared, and further improved by other neurosurgical units and trainees, fostering collaborative advancements in neurosurgical training.

Training in oncoplastic surgery for mastologists.

The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.