Development of a human cadaver model for training in laparoscopic donor nephrectomy

Area of Science:

• Surgical Education
• Transplantation Surgery
• Minimally Invasive Surgery

Background:

• The organ procurement network recommends 15 cases for surgeon proficiency in laparoscopic donor nephrectomies (LDN).
• Literature suggests the learning curve for optimal outcomes in LDN is closer to 35 cases.
• Current training options for LDN are limited.

Purpose of the Study:

• To develop and validate a simulation-based model for laparoscopic donor nephrectomies (LDN) using fresh tissue.
• To establish objective, quantifiable endpoints for assessing surgical progress and efficiency in LDN.
• To address the gap in surgical training for LDN.

Main Methods:

• Phase I involved modifying human cadavers for laparoscopic surgery visualization.
• Phase II tested learner-based metrics by timing procedural steps in novice learners performing multiport LDN on cadavers.
• A total of 35 kidneys from 21 cadavers were utilized across both phases.

Main Results:

• Timed metrics for dissection of the gonadal vein, ureter, renal hilum, adrenal and lumbrical veins showed improvement with practice.
• Simulated warm ischemic time (WIT) and operative time also improved significantly with increasing trial numbers.
• These findings demonstrate enhanced surgical efficiency and competency in the simulation model.

Conclusions:

• Human cadavers provide a viable platform for LDN surgical training.
• The developed simulation model effectively utilizes timed, learner-based metrics to document surgical progress.
• This simulation-based approach offers a valuable supplement to existing training modalities for LDN.