Perfused Cadaver: Augmentation of Cadaver-Based Surgical Simulation

INTRODUCTION: Simulation-based training has become a crucial adjunct to surgical training, allowing advanced trainees to acquire and refine technical skills in a risk-free environment. Simulation models vary in fidelity, cost, and application, and include virtual reality platforms, box trainers, animal tissue, synthetic models, and cadaver-based training. Traditionally, the live porcine model has been used as an alternative to cadaveric dissection when practicing hemostatic techniques, as cadaver models inherently lack perfused vessels. Porcine models can incur substantial cost and require anesthesia and specialized facilities. The perfused cadaver model combines the advantages of both human cadavers and live porcine models, enabling surgery on human anatomy while maintaining perfused blood vessels. OBJECTIVE: To present the advantages of the perfused cadaver model, an innovative enhancement to a well-established simulation system. METHODS: We created a video highlighting the application of the perfused cadaver model. The cadaver is perfused with bovine blood via two catheters, one in the carotid and the other in the femoral artery. This pump is used for continuous circulation, allowing for variability in pressure depending on the needs of the simulation. RESULTS: This video demonstrates two types of surgical procedures, critical for advanced gynecologic learners. We demonstrate the dissection of the retropubic space, comparing the perfused cadaver model to a non-perfused cadaver model. The video illustrates the need for a meticulous dissection in the perfused cadaver. We also compare the dissection of the pelvic sidewall in a live porcine model to the perfused cadaver model. In both instances, increased attention is required during the pelvic sidewall dissection to ensure adequate control of hemostasis. However, the perfused cadaver model is more realistic to the live surgical experience. During the dissection, the uterine artery is intentionally cut, resulting in pulsatile bleeding that rapidly fills the pelvic sidewall space. This allows learners to practice suctioning, identifying and clamping the uterine artery, and using a sponge to control bleeding and aid with visualization. The perfused cadaver model also allows the learners to practice using other hemostatic agents, such as fibrin glue spray or polysaccharide hemostatic powder. CONCLUSIONS: The perfused cadaver model allows for simulated surgery on human anatomy while allowing for practicing hemostatic techniques. This creates a higher-stakes simulation model that provides training in expeditious management of hemostasis to ensure patient safety. It is an innovative adjunct to advanced surgical training.