A Novel Pancreaticojejunostomy Training Model Utilizing Deceased Donor Pancreas

Abstract

Introduction: Pancreaticoduodenectomy (PD) is a complex operation with high postoperative morbidity, largely driven by pancreaticojejunostomy (PJ) leak. In 2021, US general surgery residency graduates performed only 9.5 ± 7 pancreatic operations, suggesting a need for additional experience with complex pancreatic anastomosis. We hypothesized that human deceased donor pancreas and jejunum could be utilized to create a high-fidelity PJ training experience.

Methods: Faculty pancreas surgeons were surveyed to determine factors influencing resident participation in PJ and expected impact of a proctored deceased donor PJ lab. Pancreata unsuitable for transplantation were recovered from adult donors with consent for research and education. Organs were procured as if for transplant, stored at -80^oC, and thawed for use at the hospital-based organ recovery center. Twenty-three surgical residents were recruited as volunteer participants. They were provided with a step-by-step diagram and an annotated video of PJ technique developed specifically for the lab. They then performed the PJ anastomosis with one-on-one faculty proctoring. Participants were surveyed before and after the lab, and after participating in a PD to assess impact.

Results: Among faculty pancreas surgeons, 63.6% cited residents' inadequate exposure to PJ, technical skill, or understanding of a complex anastomosis as barriers to full participation in PJ in the operating room. Eighty-two percent of faculty affirmed that a PJ lab would lead to greater resident PJ involvement. Resident participants in the PJ lab indicated that the experience led to improvements in the following domains: confidence (86.9%), understanding of anatomy (73.9%), understanding of anastomotic technique (82.6%), execution of a complex anastomosis (82.6%), stitch placement (73.9%), and tissue handling (69.6%). One hundred percent of residents who participated in a PD after the PJ lab reported improved tissue handling, improved stitch placement, and improved understanding of anatomy.

Conclusions: This study serves as a proof of concept that deceased donor organs can be used as an effective tool for surgical training, with potential applications across surgical disciplines.

Keywords: Knowledge donation; Pancreaticoduodenectomy; Surgical education; Surgical simulation.