For this particular patient, deep incisions will be made in his upper right chest and around the neck, exposing red flesh. Meanwhile, a tube, inserted into the femoral artery, pumps “blood” into the vessels.
It seems like a live surgery, but it is not. Other than the body being a cadaver, this is as real as surgery can get. This is perfused cadaver training, a new, innovative training model at the West Virginia University School of Medicine that mimics real-world surgery for surgical residents and trainees.
WVU is only one of a few universities in the country using this model, which puts surgical trainees in simulated operating rooms with fresh cadavers connected to machines that pump fake blood through the body. The machine allows the blood vessels and tissues to “bleed” as they would in live patients, thus requiring trainees to stop the bleeding. The fake blood is a concoction of water and red Crayola washable paint.
Dr. Daniel Grabo, director of trauma education at WVU, helped bring the concept to the University after spending time as a Navy surgeon in Los Angeles. There, he helped develop a cadaver training program in collaboration with the University of Southern California.
“Surgical training is at a crossroads as we struggle to provide our students and trainees opportunities for hands-on experience,” Grabo said. “These include life-saving trauma, open vascular and liver surgeries, to name a few.”
“When you have to do big, open procedures, you need the experience and training, and this will prepare me for that by being exposed to vessel injuries and anatomy.” -Dr. Cara Lyle
WVU introduced the Fresh Tissue Training Program in June 2018. While medical students
typically train on cadavers throughout their education, this perfused model works
with only fresh cadavers, which evokes more realism. There are stark differences
between fresh and embalmed cadavers, Grabo explained.
“An embalmed cadaver has leathery tissue,” Grabo said. “It doesn’t look like a fresh cadaver. You have a hard time recognizing that they’re not alive. The tissue and muscle are red, the fat is yellow and the vessels look normal.
“Because trainees are conducting procedures on fresh tissue, it’s high fidelity. It feels real. When they make cuts, it bleeds.”
The School of Medicine receives the cadavers from donors through the Human Gift Registry shortly after they pass away. The bodies must be used within a month and are cremated once trainings are complete. The cadavers are treated respectfully, as the doctors and trainees have a moment of silence before practicing on them.
This high-fidelity model is now part of the Advanced Surgical Skills for Exposure in Trauma, or ASSET course, for general surgery residents, which is an overview of key surgical exposures in five key anatomic areas: neck, chest, abdomen and pelvis, and upper and lower extremities.
For one resident, the training provided immediate results.
Dr. Patrick Bonasso, a four-year surgery resident from Fairmont, W.Va., completed a simulated neck procedure with a cadaver the same day he performed the real operation on a live patient.
“You can read about it all you want, but being thrown into the scenario multiple times throughout training makes the real thing less difficult and stressful,” said Bonasso, who plans for a career in pediatric surgery.
Dr. Cara Lyle, a fifth-year resident from Ford City, Pa., will also benefit from the training. She wants to specialize in vascular surgery.
“Vascular surgery is becoming less open and invasive, which is great for patients,” Lyle said. “But when you have to do big, open procedures, you need the experience and training, and this will prepare me for that by being exposed to vessel injuries and anatomy.”
Lyle also noted that most medical students only learn about anatomy firsthand during their first year. The perfused model gives students a needed refresher.
The training is not limited to WVU students and residents, either. Surgeons and medics with the United States Armed Forces are using the program several times a month, Grabo said.
“Any general and trauma surgeon in the state can come here and do this,” he said. “We’re also training surgeons today who may no longer be proficient in these operations when it comes to vascular surgeries.”
The program is a collaborative effort between WVU’s Critical Care and Trauma Institute and the Departments of Pathology and Surgery.
“I don’t do this on my own,” Grabo said. “It doesn’t belong to me or any specific department. We all work together for a greater good and because we love to teach.”