Orsi Academy Surgery training (Orsi Academy Surgery training)
Owner/Developer: Orsi Academy
05 December 2010
EFRO (European Fund for Regional Development)
At Orsi Academy, we use four different species of animals as training models (chicken and dog cadavers and anesthetised live pigs and sheep). For all live models we implement the 3Rs principles of reduction, refinement and replacement as much as possible. After every procedure we harvest the organs of the animals to reduce the number needed per year for other training needs. Furthermore, we use a lot of plastic and 3-D printed organs in the beginning of every surgeon’s learning curve.
All members of the animal care team receive continuing education and training commensurate with their positions and responsibilities. Before they can work with the animals, they must provide us with the necessary certificates of accreditation. All programs in which animals are needed must be approved by an independent ethical committee. Such a committee consists of independent lay-members, veterinary surgeons, animal welfare experts, animal care staff and academic representation from outside the animal research field. Only where a program is deemed necessary and justifiable by this committee and with due consideration to the 3Rs will it be performed at Orsi Academy. To this end, we strictly adhere to the principles which demand that where a non-animal approach to research exists, it should be used.
Hands-on training, Lecture
Optional / Voluntary
1 to 5 days, different types
Professionals (e.g. veterinarians), Other
Continuing Professional Development
Models of animals (e.g. mannequins, simulators, cadavers), Carrying out procedures on animals
Substantial coverage (e.g. multiple modules)
Pigs (Sus scrofa domesticus), Dogs (Canis familiaris), Sheep (Ovis aries), Chickens (Gallus gallus domesticus)
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THE CHICKEN CADAVER
The chicken model is used to train surgeons in anastomosis suturing skills. We buy these chickens cadavers from a butchery. They are partially emptied and only the stomachs and esophagus stay present. An 18F catheter is placed from the esophagus through to the first stomach. In the “pelvic box”, a laparoscopic section of the esophago-glandular-stomach junction and a suture between the two edges can be performed in the same fashion as for a urethrovesical suture in robotic radical prostatectomy. After use they are collected as medical waste by a specialized company.
THE CANINE CADAVER
The canine model is used to train surgeons in the different steps required in robotic radical prostatectomy, pelvic lymphadenectomy, cystectomy, neobladder reconstruction and ureter re-implantation. We buy these canine cadavers from the faculty of veterinary medicine, who collected the cadavers from shelters in the region. The reproductive system of the male dog is very similar to that of the human. Especially the anatomy of the prostate. It’s for this reason that the canine model is preferred above the porcine model for prostatectomy training. After use the cadavers are collected by Rendac, a company that specialises in processing animal cadavers.
THE PORCINE MODEL
The pig is a regularly used model for surgical training due to the similar anatomy and size of the organs. The experience of working with a living creature is an important step in the learning curve of surgeons. In real surgeries, control of bleeding is a key part of the process. It is very difficult to simulate all the intricacies of this process. Therefore, an anesthetized pig is used to simulate intra-operative situations such as vascular injury and urine leakage. But also many other subtleties can only be simulated in a live model, including how the tissue looks, feels and responds.
The pigs are provided by either the Institute for Agriculture, Fisheries and Nutritional Research or RA-SE Genetics. These pigs are not purpose bred for research, however, they are genetically selected on being negative for malignant hyperthermia - a condition that is transmitted as an autosomal dominant gene. It is induced by stress (porcine stress syndrome) or by anesthetic and paralytic agents.
The pigs arrive at Orsi Academy one week prior to the programs in which they will be used. During this week, they can acclimatize to the stable environment and get used to the staff. They are housed in groups on straw bedding and are provided with enrichment for physiological well-being, such as plastic balls and metal chains to play with.
Before the start of a program, a team of veterinarians and animal care technicians escort the required number of pigs into a transportation cart. This is done without any restraint or stress inducing maneuvers. Once in the cart, they are transported to the preparation room inside the building. For each project, we aim to provide a specific anesthetic that takes into consideration the type of surgery as well as the expected pain intensity. For initial sedation, all our pigs are given and injection into the muscle of ketamine (NMDA-antagonist), medetomidine (α2-agonist) and morphine (mu – opioid agonist).
Any stimulation in the following 10 – 15 minutes is therefore avoided, facilitating a firm and deep sedation. When sedated, the animal is brought inside the operating room and a catheter is placed in the marginal ear vein to introduce a general anesthetic. Endotracheal intubation is performed on every anesthetized pig to allow safe and adequate anesthesia with volatile anesthetics (isoflurane or sevoflurane).
Before intubation, the larynx is sprayed with a topical anesthetic while being observed with a laryngoscope. Depending on the expected pain intensity and the parameters monitored during surgery, supplemental analgesia is provided. All animals receive a constant rate infusion of lidocaine to provide good analgesia, (specifically gastro-intestinal). Lidocaine also has an anti-inflammatory and anti-arrhythmic potency. Advanced analgesic techniques such as epidural injection and/or constant rate infusions with NMDA-antagonist (ketamine) are given in addtion when high pain intensity is expected.
During the whole day, the pig is constantly monitored by at least one veterinarian and one animal care taker. The depth of anesthesia is controlled by checking the jaw tone or the absence of any reflex when pinching. The most sensitive indicators of a light plane of anesthesia are an increased heart rate and blood pressure. Blood pressure is monitored using peripheral vascular cuffs. When neuromuscular blocking agents are used or critical surgeries are performed, invasive blood pressure measurement is used. Furthermore ECG, pulse-oximetry, spirometry and capnography are also used for monitoring. All parameters are registered manually on specific anesthesia files. At the end of the surgery euthanasia is carried out painlessly by injecting an overdose of barbiturates (pento-barbital) intravenously.
The porcine cadavers are collected at the end of the day by Rendac.
THE SHEEP MODEL
Sheep are used to train surgeons in programs in the endovascular field. Due to the similar vascular system that they have - especially the diameter of the blood vessels - they are preferred to pigs. Sheep are also less sensitive to spasms compared to pigs. National legislation is taken into account and the sheep are always housed in groups with the opportunity to roam in the fields. The anesthetic protocol adopted depends on the species-specific requirements or the restrictions of the procedure. The sheep are provided by a shepherd and are again collected by Rendac.