Resident Barrow Neurological Institute Phoenix, Arizona, United States
Introduction: Simulation is increasingly important in neurosurgical resident education. However, traditional cadavers and fabricated models present challenges in simulating normal tissue handling and anatomy. In this study, we utilize whole-body donor cadavers (WBDs) preserved in a proprietary solution, intubated, ventilated, and perfused to create a realistic simulated OR. We asked participants to perform a standardized spinal procedure and used surveys to assess participant experience.
Methods: WBDs were acquired from local whole body donation organizations. Donors were preserved within a week of acquisition using Global Anatomix (GAX) solutions and were stored in the hospital morgue. WBDs are intubated utilizing an endotracheal tube and connected to a ventilator with settings adjusted appropriately to overcome the atelectasis associated with death and to simulate breath. Expired blood products are obtained from the hospital’s blood bank and are pumped through the internal carotid artery to simulate arterial flow. A trained scrub nurse sets up instrumentation and provides assistance to the surgeon. 12 participants were divided into 2 groups according to their experience: resident (n=7) and attending (n=5). Participants were asked to expose a level of the thoracolumbar spine, cannulate a pedicle for screw placement, and perform a facetectomy and laminectomy. Subjective measures were collected using a standardized survey.
Results: The attending and resident groups rated the experience as a 13.2 and 12.6, respectively, on a scale of 1 as “no similarity” and 15 as “completely identical” in replicating real surgery. 7 of the 12 participants noted bleeding produced during dissection of the cadaver to enhance the experience compared to traditional cadavers. When asked what differences participants noticed compared to a real patient, 2 noted the cold temperature of the donor, 3 noted less bleeding than a live patient, and 1 noted worse bone quality. All participants graded the experience as an upgrade to traditional cadavers and stated this model would improve surgical technique and patient care.
Conclusion : This model provides an excellent replication of the OR suite, and the tissue quality greatly exceeds that of traditional cadavers. The combination of these factors produces an experience much closer to real surgery than a traditional cadaver lab can provide.
