Surgical and Radiologic Anatomy

, Volume 40, Issue 4, pp 439–448 | Cite as

Techniques of cadaver perfusion for surgical training: a systematic review

  • A. BellierEmail author
  • A. Chanet
  • P. Belingheri
  • P. Chaffanjon
Original Article



The objective of this study was to identify the most appropriate cadaver perfusion techniques for surgical training through a systematic review with a description of the protocols used.


The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search concepts included perfusion, cadavers and simulation training, and the protocol used is reported. This resulted in a qualitative review of 12 articles out of 250 articles consulted. We collected all the important data from these 12 articles.


Regarding the characteristics of the studies and the declotting or perfusion techniques, the results were heterogeneous. Indeed, in several studies, a good deal of information was unclear or insufficiently precise, making it unfeasible to summarize the data. The methods used were not sufficiently explicit and detailed. However, a majority of the fresh cadavers used tap water for declotting. Perfusion, type of fluid, number of pumps, pressure, pulsatility, and arterial or venous approaches differed greatly. Only two studies fulfilled five of our six realism criteria for surgical simulation.


This systematic review provided an overview of all the different cadaver perfusion techniques. It could be used to establish a reference method of a simulation model.


Revascularization Perfusion Cadavers Surgical training Simulation 


Author contributions

AB: protocol/project development, data analysis, manuscript writing. AC: data collection or management, data analysis, manuscript writing. PB: data collection or management, data analysis, manuscript writing. PC: protocol/project development, manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kneebone R (2005) Evaluating clinical simulations for learning procedural skills: a theory-based approach. Acad Med J Assoc Am Med Coll 80:549–553CrossRefGoogle Scholar
  2. 2.
    Reed AB, Crafton C, Giglia JS, Hutto JD (2009) Back to basics: use of fresh cadavers in vascular surgery training. Surgery 146:757–762 (discussion 762763)CrossRefPubMedGoogle Scholar
  3. 3.
    Varga S, Smith J, Minneti M, Carey J, Zakaluzny S, Noguchi T, Demetriades D, Talving P (2015) Central venous catheterization using a perfused human cadaveric model: application to surgical education. J Surg Educ 72:28–32CrossRefPubMedGoogle Scholar
  4. 4.
    Tan SSY, Sarker SK (2011) Simulation in surgery: a review. Scott Med J 56:104–109CrossRefPubMedGoogle Scholar
  5. 5.
    Woo JA, Malekzadeh S, Malloy KM, Deutsch ES (2017) Are All Manikins Created Equal? A Pilot Study of Simulator Upper Airway Anatomic Fidelity. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 156:1154–1157CrossRefGoogle Scholar
  6. 6.
    Arbatli H, Cikirikcioglu M, Pektok E, Walpoth BH, Fasel J, Kalangos A, Bruszewski W, Numan F (2010) Dynamic human cadaver model for testing the feasibility of new endovascular techniques and tools. Ann Vasc Surg 24:419–422CrossRefPubMedGoogle Scholar
  7. 7.
    Hassan S, Eisma R, Malhas A, Soames R, Harry L (2015) Surgical simulation flexor tendon repair using Thiel cadavers: a comparison with formalin embalmed cadavers and porcine models. J Hand Surg Eur Vol 40:246–249CrossRefPubMedGoogle Scholar
  8. 8.
    Spadaro S, Karbing DS, Fogagnolo A, Ragazzi R, Mojoli F, Astolfi L, Gioia A, Marangoni E, Rees SE, Volta CA (2017) Simulation training for residents focused on mechanical ventilation: a randomized trial using mannequin-based versus computer-based simulation. Simul Healthc J Soc Simul Healthc 12:349–355Google Scholar
  9. 9.
    Plessas A (2017) Computerized virtual reality simulation in preclinical dentistry: can a computerized simulator replace the conventional phantom heads and human instruction? Simul Healthc J Soc Simul Healthc 12:332–338CrossRefGoogle Scholar
  10. 10.
    Pacca P, Jhawar SS, Seclen DV, Wang E, Snyderman C, Gardner PA, Aboud E, Fernandez-Miranda JC (2017) “Live Cadaver” model for internal carotid artery injury simulation in endoscopic endonasal skull base surgery. Oper Neurosurg Hagerstown Md 13:732–738CrossRefGoogle Scholar
  11. 11.
    Aboud ET, Krisht AF, O’Keeffe T, Nader R, Hassan M, Stevens CM, Ali F, Luchette FA (2011) Novel simulation for training trauma surgeons. J Trauma 71:1484–1490PubMedGoogle Scholar
  12. 12.
    Stefanidis D, Yonce TC, Green JM, Coker AP (2013) Cadavers versus pigs: which are better for procedural training of surgery residents outside the OR? Surgery 154:34–37CrossRefPubMedGoogle Scholar
  13. 13.
    Holcomb ZE, Chudgar SM (2018) See one, do one, teach… a lifetime. Clin Teach 15:73–75CrossRefPubMedGoogle Scholar
  14. 14.
    Nutt J, Mehdian R, Parkin I, Dent J, Kellett C (2012) Cadaveric surgery: a novel approach to teaching clinical anatomy. Clin Teach 9:148–151CrossRefPubMedGoogle Scholar
  15. 15.
    Alvernia JE, Pradilla G, Mertens P, Lanzino G, Tamargo RJ (2010) Latex injection of cadaver heads: technical note. Neurosurgery 67:362–367PubMedGoogle Scholar
  16. 16.
    Messmer C, Kellogg RT, Zhang Y, Baiak A, Leiweke C, Marcus JR, Levin LS, Zenn MR, Erdmann D (2010) A technique to perfuse cadavers that extends the useful life of fresh tissues: the Duke experience. Anat Sci Educ 3:191–194CrossRefPubMedGoogle Scholar
  17. 17.
    Carey JN, Minneti M, Leland HA, Demetriades D, Talving P (2015) Perfused fresh cadavers: method for application to surgical simulation. Am J Surg 210:179–187CrossRefPubMedGoogle Scholar
  18. 18.
    Payne DES, Kaufman AM, Wysocki RW, Richard MJ, Ruch DS, Leversedge FJ (2011) Vascular perfusion of a flexor carpi ulnaris muscle turnover pedicle flap for posterior elbow soft tissue reconstruction: a cadaveric study. J Hand Surg 36:246–251CrossRefGoogle Scholar
  19. 19.
    Rad AN, Christy MR, Rodriguez ED, Brazio P, Rosson GD (2010) The anterior tibialis artery perforator (ATAP) flap for traumatic knee and patella defects: clinical cases and anatomic study. Ann Plast Surg 64:210–216CrossRefPubMedGoogle Scholar
  20. 20.
    Rampazzo A, Kutz JE, Kaufman C, Manon-Matos Y, Bright L, Papay FA, Gharb BB (2015) A cadaver study of the feasibility of multidigit allotransplantation for reconstruction of the metacarpal hand. Plast Reconstr Surg 136:531–540CrossRefPubMedGoogle Scholar
  21. 21.
    Delpech PO, Danion J, Oriot D, Richer JP, Breque C, Faure JP (2017) SimLife a new model of simulation using a pulsated revascularized and reventilated cadaver for surgical education. J Visc Surg 154:15–20CrossRefPubMedGoogle Scholar
  22. 22.
    Garrett HE (2001) A human cadaveric circulation model. J Vasc Surg 33:1128–1130CrossRefPubMedGoogle Scholar
  23. 23.
    McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46CrossRefPubMedGoogle Scholar
  24. 24.
    Higgins J, Green S (2011) Cochrane Handbook for systematic reviews of interventions. Cochrane Collab Part 2:27–264Google Scholar
  25. 25.
    Carey JN, Rommer E, Sheckter C, Minneti M, Talving P, Wong AK, Garner W, Urata MM (2014) Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthetic Surg JPRAS 67:e42–48Google Scholar
  26. 26.
    Aboud E, Al-Mefty O, Yaşargil MG (2002) New laboratory model for neurosurgical training that simulates live surgery. J Neurosurg 97:1367–1372CrossRefPubMedGoogle Scholar
  27. 27.
    Chevallier C, Willaert W, Kawa E, Centola M, Steger B, Dirnhofer R, Mangin P, Grabherr S (2014) Postmortem circulation: a new model for testing endovascular devices and training clinicians in their use. Clin Anat N Y N 27:556–562CrossRefGoogle Scholar
  28. 28.
    de Castro Abreu AL, Chopra S, Azhar RA, Berger AK, Metcalfe C, Minetti M, Carey JN, Ukimura O, Desai M, Gill IS (2015) Robotic transabdominal control of the suprahepatic, infradiaphragmatic vena cava to enable level 3 caval tumor thrombectomy: pilot study in a perfused-cadaver model. J Endourol 29:1177–1181CrossRefPubMedGoogle Scholar
  29. 29.
    Jongkind V, Yeung KK, Linsen MAM, Heidsieck D, Coveliers HME, Hoksbergen AWJ, Wisselink W (2010) Direct videoscopic approach to the thoracic aorta for aortic endograft delivery: evaluation in a human cadaver circulation model. J Endovasc Ther Off J Int Soc Endovasc Spec 17:12–18Google Scholar
  30. 30.
    Olabe J, Olabe J, Sancho V (2009) Human cadaver brain infusion model for neurosurgical training. Surg Neurol 72:700–702CrossRefPubMedGoogle Scholar
  31. 31.
    Faure JP, Breque C, Danion J, Delpech PO, Oriot D, Richer JP (2017) SIM Life: a new surgical simulation device using a human perfused cadaver. Surg Radiol Anat SRA 39:211–217CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medical EvaluationGrenoble Alpes University HospitalLa TroncheFrance
  2. 2.Laboratoire d’Anatomie Des Alpes Françaises, Faculty of MedicineGrenoble Alpes UniversityLa Tronche CedexFrance
  3. 3.GIPSA-Lab, Dpt. Parole et Cognition, UMR 5216Saint Martin d’Hères CedexFrance

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