Role of the Cadaver Lab in Lymphatic Microsurgery Education: Validation of a New Training Model

Abstract

Background

Microsurgical transplantation of vascularized lymph nodes (VLNT) or lymphatic vessels (VLVT) alongside derivative lymphaticovenous procedures are promising approaches for treatment of lymphedema. However, clinically relevant training models for mastering these techniques are still lacking. Here we describe a new training model in human cadaver and validate its use as training tool for microsurgical lymphatic reconstruction.

Methods

10 surgeons with previous exposure to microsurgery were trained in a controlled environment. Lymphatic vessel mapping and dissection in 4 relevant body regions, harvesting of five different VLNTs and one VLVT were performed in 5 fresh-frozen cadavers. The number of lymphatic vessels and lymph nodes for each VLNT were recorded. Finally, the efficacy of this model as training tool was validated using the Dundee Ready Education Environment Measure (DREEM).

Results

The average cumulative DREEM score over each category was 30,75 (max = 40) while individual scoring for each relevant category revealed highly positive ratings from the perspective of teaching (39,3), training 40,5 (max = 48) and self perception of the training 30,5 (max = 32) from all participants. The groin revealed the highest number of lymphatic vessels (3.2 ± 0.29) as all other regions on the upper extremity, while the gastroepiploic VLNT had the highest number of lymph nodes (4.2 ± 0.37).

Conclusions

This human cadaver model represents a new, reproducible “all-in-one” tool for effective training in lymphatic microsurgery. Its unique diligence in accurately reproducing human lymphatic anatomy, should make this model worth considering for each microsurgeon willing to approach lymphatic reconstruction.

Aknowledgements

The authors would herewith express their sincere thank for all those who donated their bodies to science so that this study could be performed. These donors and their families deserve our highest gratitude. Additionally we would like to thank Mr. Klaas van Linschoten for his continuous support, outstanding work and dedication as prosector.

Disclosure statement

All the authors have read and agree to abide by the Journal of Investigative Surgery Conflict of Interest policy. We acknowledge that we must disclose any conflict of interest, along with a description of any personal business interest, affiliation, or activity with any entity which may give rise to a conflict of interest. The authors of this study have no conflicts of interest to disclose.