Formalin-free soft embalming of human cadavers using N-vinyl-2-pyrrolidone: perspectives for cadaver surgical training and medical device development

Nagase, Miki; Nagase, Takeshi; Tokumine, Joho; Saito, Koichiro; Sunami, Eiji; Shiokawa, Yoshiaki; Matsumura, George

doi:10.1007/s12565-022-00664-9

Cited by 6 publications

(10 citation statements)

References 40 publications

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“…Advancements in embalming procedures have further improved the realism of cadaver-based training. [ 18 19 ] Simulation using virtual reality (VR) and augmented reality (AR): Several simulators using VR and AR are commercially available, providing a more immersive experience in training technical and non-technical skills. The cost of acquiring and maintaining such equipment is high and may indeed be prohibitive.…”

Section: Discussionmentioning

confidence: 99%

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Novel teaching–learning and assessment tools to complement competency-based medical education in postgraduate training

Joshi

2024

Indian Journal of Anaesthesia

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Medical and educational techniques and approaches have evolved globally over the past few decades. The modern approach is more learner-centred, with a focus on the acquisition of skills. The recently implemented competency-based medical education (CBME) for the National Medical Commission (NMC) undergraduate course curriculum is also competency-based rather than an outcome-based traditional curriculum. It is vital to embrace innovative teaching–learning and educational strategies to achieve the aspiration of CBME. This article provides a list of some of the newer tools and their perceived advantages and challenges and serves as a guide for using these methods effectively to meet the objectives of CBME as proposed by the NMC. Virtual teaching, learning from digital resources, objective-structured practical and clinical examination, flipped classroom, case-based learning, serious gaming, simulation-based learning and learning from role-plays and portfolios emerged as novel instructional strategies.

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Section: Discussionmentioning

confidence: 99%

“…Advancements in embalming procedures have further improved the realism of cadaver-based training. [ 18 19 ]…”

Section: Discussionmentioning

confidence: 99%

Novel teaching–learning and assessment tools to complement competency-based medical education in postgraduate training

Joshi

2024

Indian Journal of Anaesthesia

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“…However, if these agents are not completely spread over the entire lumen, the structures cannot be observed accurately. Thus, the molding of the entire joint cavity is best performed in a cadaver that has undergone Thiel or NVP fixation because the flexibility of the soft tissue around the arthrodesis is preserved (Erich, 2014; Haizuka et al, 2018; Nagase et al, 2022; Thiel, 1992; Thiel, 2002). Because the joint needs to be moved for the latex or epoxy resin to spread over the entire joint capsule, a cadaver immobilized by NVP or Thiel is preferred.…”

Section: Discussionmentioning

confidence: 99%

A new injection method for identifying the subpopliteal recess of the knee

Tabira,

Yamashita,

Kikuchi

et al. 2024

Clinical Anatomy

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The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin‐containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty‐two formalin‐fixed cadavers (34 knees), two N‐vinyl‐pyrrolidone (NVP)‐fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1–3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

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“…Particularly, the use of formalin fixation induces considerable tissue stiffness, rendering formalin-fixated specimens unsuitable for the establishment of extracorporeal perfusion. 28 To account for this limitation, we designed our study setup based on fresh-frozen cadavers whose preparation is technically equivalent to a conventional surgical procedure. Based on that model, the presented study compares the image quality of dose-matched CTA of the lower extremity runoff between a first-generation PCD-CT and a third-generation dual-source EID-CT.…”

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confidence: 99%

“…Although cadaveric studies constitute a mainstay of skeletal imaging research, vascular imaging is naturally problematic due to the lack of inherent blood flow. Particularly, the use of formalin fixation induces considerable tissue stiffness, rendering formalin-fixated specimens unsuitable for the establishment of extracorporeal perfusion 28 . To account for this limitation, we designed our study setup based on fresh-frozen cadavers whose preparation is technically equivalent to a conventional surgical procedure.…”

mentioning

confidence: 99%

Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

et al. 2023

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Objectives Detailed visualization of the arterial runoff is mandatory for the assessment of peripheral arterial occlusive disease. This study aims to compare the performance of a first-generation photon-counting detector computed tomography (PCD-CT) to a third-generation energy-integrating detector CT (EID-CT). Materials and Methods Computed tomography angiographies of 8 upper leg arterial runoffs were performed on human cadaveric models with continuous extracorporeal perfusion. For both PCD-CT and EID-CT, radiation dose-equivalent 120 kVp acquisition protocols (low-/medium-/high-dose: CTDIVol = 3/5/10 mGy) were used. All scans were performed with standard collimation (PCD-CT: 144 × 0.4 mm; EID-CT: 96 × 0.6 mm), a pitch factor of 0.4, and a gantry rotation time of 1.0 second. Reformatting of data included the use of comparable vascular kernels (Bv 48/49), a slice thickness and increment of 1.0 mm, and a field of view of 150 × 150 mm. Eight radiologists evaluated image quality independently using a browser-based pairwise forced-choice comparison setup. Kendall concordance coefficient (W) was calculated to estimate interrater agreement. Signal-to-noise ratio and contrast-to-noise ratio (CNR) were compared based on 1-way analyses of variance and linear regression analysis. Results Low-dose PCD-CT achieved superior signal-to-noise ratio/CNR values compared with high-dose EID-CT (P < 0.001). Linear regression analysis suggested that an EID-CT scan with a CTDIVol of at least 15.5 mGy was required to match the CNR value of low-dose PCD-CT. Intraluminal contrast attenuation was higher in PCD-CT than EID-CT, irrespective of dose level (415.0 ± 31.9 HU vs 329.2 ± 29.4 HU; P < 0.001). Subjective image quality of low-dose PCD-CT was considered superior to high-dose EID-CT (P < 0.001). Interrater agreement was high (W = 0.989). Conclusions Using cadaveric models with continuous extracorporeal perfusion allows for intraindividual image quality comparisons between PCD-CT and EID-CT on variable dose levels. With superior luminal contrast attenuation and denoising in angiographies of the peripheral arterial runoff, PCD-CT displayed potential for radiation saving of up to 83% compared with EID-CT.

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Formalin-free soft embalming of human cadavers using N-vinyl-2-pyrrolidone: perspectives for cadaver surgical training and medical device development

Cited by 6 publications

References 40 publications

Novel teaching–learning and assessment tools to complement competency-based medical education in postgraduate training

Novel teaching–learning and assessment tools to complement competency-based medical education in postgraduate training

A new injection method for identifying the subpopliteal recess of the knee

Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

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