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History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method

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Abstract

Traditionally, surgical training meant on-the-job training with live patients in an operating room. However, due to advancing surgical techniques, such as minimally invasive surgery, and increasing safety demands during procedures, human cadavers have been used for surgical training. When considering the use of human cadavers for surgical training, one of the most important factors is their preservation. In this review, we summarize four preservation methods: fresh-frozen cadaver, formalin, Thiel’s, and saturated salt solution methods. Fresh-frozen cadaver is currently the model that is closest to reality, but it also presents myriad problems, including the requirement of freezers for storage, limited work time because of rapid putrefaction, and risk of infection. Formalin is still used ubiquitously due to its low cost and wide availability, but it is not ideal because formaldehyde has an adverse health effect and formalin-embalmed cadavers do not exhibit many of the qualities of living organs. Thiel’s method results in soft and flexible cadavers with almost natural colors, and Thiel-embalmed cadavers have been appraised widely in various medical disciplines. However, Thiel’s method is relatively expensive and technically complicated. In addition, Thiel-embalmed cadavers have a limited dissection time. The saturated salt solution method is simple, carries a low risk of infection, and is relatively low cost. Although more research is needed, this method seems to be sufficiently useful for surgical training and has noteworthy features that expand the capability of clinical training. The saturated salt solution method will contribute to a wider use of cadavers for surgical training.

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Acknowledgments

This paper is based on the winning lecture of encouragement award of the JAA at the 120th annual meeting of the Japanese Association of Anatomists held at Kobe Convention Center on 22 March 2015. This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Numbers 26463257 and 26670254. The special ST session for our previous study (Hayashi et al. 2014) was held with support from the Ministry of Health, Labour and Welfare, Japan. The authors declare that they have no conflicts of interest. The authors wish to thank Ms. Yuki Ogawa, Ms. Miyuki Kuramasu, and Ms. Keiko Kuwana for excellent secretarial assistance and Mr. Koichi Koyama for excellent technical assistance.

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Authors and Affiliations

  1. Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan

    Shogo Hayashi, Shinichi Kawata, Ning Qu, Naoyuki Hatayama, Shuichi Hirai & Masahiro Itoh

  2. Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan

    Munekazu Naito

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  1. Shogo Hayashi
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  2. Munekazu Naito
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  3. Shinichi Kawata
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Correspondence to Shogo Hayashi.

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Hayashi, S., Naito, M., Kawata, S. et al. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anat Sci Int 91, 1–7 (2016). https://doi.org/10.1007/s12565-015-0299-5

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