The Usefulness of Cadaveric Hands-on Workshop for Surgical Training in Head and Neck Surgeries

Abstract

Surgical approach to head and neck region requires in depth anatomical knowledge and refined surgical skills due to highly critical and complex anatomy of this region.

To look for the benefit of cadaveric hands-on workshop on enhancing the surgical knowledge and confidence of the participants. Freshly frozen cadavers were used for this hands-on course in the department of Anatomy, AIIMS Raipur involving 32 residents and ENT specialists. This course involved the interactive lectures and live surgical demonstration on issues related to neck dissection, thyroid, and parotid surgery followed by a hands-on practice by the residents. A positive feedback was given by the participants in regards to the cadaveric hands-on workshop. Almost 4/5th of the participants found the present experience to be extremely helpful and all of them believed the cadaveric hands-on workshops should be conducted regularly as a learning tool and enhancement of surgical skills. Cadaveric hands-on dissection is a very effective practice for refining surgical skills. It can be used to study basic surgical procedures or extremely complex surgeries having intricate anatomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04182-6.

Introduction

For surgical training and medical practice, an understanding of anatomy is required [1]. Even though cadaveric dissection and anatomy remain important topics in the first year of medical school, there is less time spent on them [1–3]. Nearly the past century, the amount of time spent on gross anatomy in the medical curriculum has declined, from nearly 550 h in 1902 to 50 h in 2000. A major decline in anatomy instruction, in particular among surgeons, is unjustifiable in the eyes of many medical professionals [4]. The challenges of applying gross anatomy knowledge in the operating room are a result of fewer hours spent in the gross anatomy lab [5].

Due to the presence of highly critical structures and complex anatomy, head and neck procedures demand excellent surgical skills. The approach to this region requires thorough anatomical knowledge and expertise because several large veins and significant nerves run alongside these glands, making it challenging for inexperienced surgeons to identify structures when performing surgery. Numerous studies have demonstrated that pre-operative training in cadaver lab improves surgical ability [6]. However, the majority of post-graduate students in India lack hands-on experience with cadaver dissection. Cadaveric dissection was included in the competency-based medical education in ENT under the most recent postgraduate regulations published by the National Medical Commission (NMC), however details on its length, topics to be addressed, and requirement that it be completed during residency were left out.

Due to the lack of cadavers, simulated labs provide an alternative, but the effectiveness of the learning is still up for debate. Furthermore, they are challenging to install in each speciality due to their high cost. These factors prevent the residents from developing their talents and reaching their potential. The constraints mentioned above can be solved by cadaveric dissection courses offered by various institutions. Nevertheless, a number of residents are still unable to enrol in these courses due to a lack of seats as well as logistical and budgetary restrictions. To further understand their viewpoint on the value of cadaver dissection in surgical training, we conducted pilot research among participants in a cadaveric dissection course.

Methods

An interactive course using freshly frozen cadavers was designed to give attendees first-hand experience with the crucial neck structures encountered during surgical procedures. The event attracted 32 residents and ENT specialists. The experts (anatomists and head and neck surgeons) gave interactive lectures on issues related to neck dissection, thyroid, and parotid surgery, followed by a live surgical demonstration. Under the direct supervision of experts, a team of two participants performed several surgical procedures, including neck dissection, on either side of the head and neck regions.

Following the hands-on training, each participant received a questionnaire and feedback form to assess the workshop’s value in terms of their level of surgical anatomy comprehension and the development of their surgical abilities. Participants were given a questionnaire that contained two yes/no questions and eight questions in which they were to rate their choices using a Likert’s scale.

Results

A total of 32 people attended, including 13 residents, 16 senior residents, two assistant professors, and one tutor. The most pertinent questions and their answers for this study were added to the questionnaires once they had been gathered and structured further.

In general, respondents had a favorable opinion of the workshop and thought it was extremely helpful. Approximately one third of the participants (27.58%) were found to have never dissected a human cadaver while they were in medical school, and a similar percentage (31.25%) were found to have not done so even after graduating. More than 10 cadaveric dissections have been completed by 6.25% of the participants. Although there are differing opinions among the participants as to the value of a multi-specialty environment for training and personal development, 62.06% of them regarded it to be extremely helpful. Cadaveric hands-on workshops were deemed to be extremely helpful by the majority of participants (79.32%) in terms of refining their surgical abilities, and extremely helpful by 48.28% in terms of boosting their confidence during surgery.

Discussion

By using an instructional programme based on anatomy, the most efficient surgical teaching is delivered using fresh cadavers [7]. The most effective way of learning is said to be cadaveric dissection during surgical training [8]. Through better maintained tissue fascial planes, colour, tissue plasticity, and elasticity, which have a substantial impact on surgical training [9, 10], cadaveric dissection is used to teach students or train surgeons about various surgical procedures.

In the recent years, a variety of virtual, mannequin, and computer simulations have been developed for improving surgical abilities and are preferred over actual human cadaveric dissection [11–15]. Simulators are digitally coded and offer 3D visuals as well as the option to repeat different surgical procedures. But it doesn’t have the tissue’s texture or the body’s normal abnormalities.

We discovered that some participants had never performed cadaveric dissection during medical school or during residency. The cadaveric dissection session helped them to better comprehend the fundamentals of head and neck anatomy. Participants were adamant that practicing surgical procedures on actual human cadavers would increase their level of comfort performing surgery on real patients. Arora et al. [16] carried out a similar study with 35 residents to evaluate the effect of the dissection course on the development of surgical skill. They observed that both knowledge and operational confidence had significantly improved. The majority of participants thought that learning procedural anatomy and technical competence were improved by cadaveric dissection. The majority of participants thought that learning procedural anatomy and technical competence were improved by cadaveric dissection. The majority of participants thought that cadaveric dissection was a superior training tool for surgery than virtual simulators or multimedia technologies.

From simple procedures like endotracheal intubation, suturing skin and underlying tissue, venous cut-down, etc., to highly complex surgeries like pedicle screw placement in the spine, joint replacement surgeries, laparoscopic abdominal surgeries, etc., cadaveric dissection can be used to improve both fundamental and advanced surgical skills [1, 2, 8]. Senior academics, consultants, and surgeons can all greatly benefit from hands-on cadaveric dissection workshops to improve their abilities or learn new ones in addition to postgraduate students and senior residents [8, 17–19].Despite the fact that this survey showed human cadaver dissection classes to be superior than simulated labs, the lack of cadavers for these educational courses and even for fundamental medical training is becoming a concern. We initiated a body donation programme in our institute to address this scarcity. This has led to a large number of body donations, which has aided our cadaver skill lab training, research, and instruction. A computer simulator or virtual mannequin can serve as an alternative to a human body, but they are unable to replicate the sensation of genuine tissue. These simulated labs can be used to supplement cadaver learning, but they cannot take its place entirely. A survey of 292 medical students was conducted by Darras et al. [20] to determine how virtual anatomy dissection affected their understanding of cadaveric anatomy. They discovered that virtual dissection, followed by student-led cadaveric dissection and improved learning. They recommended combining these modern teaching resources with cadaveric learning. Fox et al. [21] recommendation to combine virtual and cadaver labs in anatomy instruction is similar. Furthermore, Frithioff et al. [22] research revealed that residents had improved surgical skills for mastoidectomy. We concur with Darras et al., however the high cost of these contemporary tools continues to be the principal disadvantage in the under-funded centres.

We came to the conclusion that cadaveric dissection is unquestionably the most effective technique for improving surgical abilities. It can be used to study fundamental surgical procedures or extremely complex surgery. We believe that due to the complicated anatomy of the head and neck, ENT surgeons should attend cadaveric dissection courses rather than virtual labs.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

All authors contributed equally for the study and development of manuscript.

Funding

No funding received.

Data Availability

All the data available with the corresponding author.

Declarations

Conflict of intrest

There was no conflict of interest among all the authors.

Consent to Participate

Written informed consent was taken from all the participants involved in the study.

Ethical Approval

The ethical policies in general have been followed which involves the use of cadavers for research and training purposes by the institute. This informed consent is taken at the time of donation of body. The study was performed in accordance with principles of Declaration of Helsinki.