The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training.

STUDY OBJECTIVE

The value of a cadaver training program in laparoscopic surgery has rarely been studied. As there is a dearth of cadaver training programs, it is important to evaluate them. The goal of this study was to estimate if our cadaver training program significantly and relatively rapidly taught residents laparoscopic surgical skills.

DESIGN

Observational, timed comparative study (Canadian Task Force classification II-3).

SETTING

University of Louisville School of Medicine, Fresh Tissue Laboratory, Louisville, KY.

PARTICIPANTS

Twenty-nine obstetric/gynecology residents (15 postgraduate year PGY 2 and 14 PGY 3) participated in the study.

INTERVENTION

During 5 half days, we compared the performance of each postgraduate year (PGY) 2 and PGY 3 obstetric/gynecology resident to his or her own results on five outcome skills before and after training in lightly embalmed cadavers. The testing was performed at the beginning and at the end of the week so that all improvement was secondary only to the training experience with the cadaver. Residents were assessed using laparoscopic techniques in a physical-reality simulator for three outcomes: bead transfer time, number of beads transferred, and suturing time on a stuffed vinyl glove and in two specific areas of the cadaver pelvis, with one slightly more difficult than the other. Assessment of suturing time was made on the two distinct tasks using the embalmed cadavers. Although the number of residents was relatively small, it covered two levels for one year.

MEASUREMENTS AND MAIN RESULTS

The residents were assessed on a simulator before and after laparoscopic surgical training on the cadaver. The median decrease in bead transfer time (task I, simulator) was 38.5 seconds (p=.02); 69% of the residents showed some reduction in time to complete this task. The median increase in the number of beads transferred (task II, simulator) was 2.5 beads (p=.0001); 72.4% of the residents transferred at least one more bead after training. The median decrease in suture time (task III, simulator) was 63.5 seconds (p=.001); 79.3% of the residents performed this task more quickly after training. The median decrease in suture time (task IV, cadaver) was 54.5 seconds (p=.001); 72.4% of the residents showed improved performance on this task after training. The median reduction in suture time (task V, cadaver) was 53.5 seconds (p<.001); 82.8% of the residents completed this task more quickly after training.

CONCLUSIONS

This cadaver surgical training program appeared to significantly improve laparoscopic surgical techniques in PGY 2 and PGY 3 obstetric/gynecology residents in a relatively short time. This model teaches residents specific training in the handling and manipulation of tissue as well as practice in surgical techniques for adnexal surgery, pelvic dissection, laparoscopic hysterectomy, and dissection within the space of Retzius that is not possible with mechanical trainers.