American Association of Plastic Surgeons

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A Novel Swine Surgical Simulation Model For Teaching The Norwood Procedure
Constantine D. Mavroudis, MD, MSc1, Constantine Mavroudis, MD2.
1Hospital of the University of Pennsylvania, Philadelphia, PA, USA, 2Florida Hospital for Children, Orlando, FL, USA.

Objective(s): There are many challenges inherent to learning and teaching complex neonatal surgical techniques such as the Norwood procedure. Current surgical simulation techniques are limited in their use, and none in current use leverages the advantages offered by using an animal model such as tissue fidelity, anatomical relationships, and the ability to expose and dissect the tissue. In this video, we demonstrate how the essential techniques of the Norwood operation can be simulated and taught using a freshly sacrificed neonatal piglet model.
Methods: Specific techniques demonstrated in this video include great vessel dissection, mobilization, and control; arterial cannulation for selective antegrade cerebral perfusion; neoaortic arch reconstruction; pulmonary artery and aorta amalgamation; main pulmonary artery isolation; and right ventricle to pulmonary artery shunt creation. Anastomoses are tested via antegrade instillation of saline through an additional right ventriculotomy.
Results: The use of a sacrificed animal obviates the need for the additional personnel and resources required for cardiopulmonary bypass and anesthesia, while maximizing pedagogical opportunities by affording time to explain finer points without the pressure of circulatory arrest and operative time. While normal neonatal swine anatomy differs from that of a human neonate with hypoplastic left heart syndrome, the essential components of the Norwood procedure can still be simulated in a high fidelity manner.
Conclusions: This educational model can be adapted to complement congenital heart surgical training and maximize trainee comfort with complex operations while minimizing potential morbidity to patients during the steep learning curve associated with any complex neonatal cardiac surgical procedure.


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