Review / Derleme DOI: 10.4274/tjod.galenos.2018.

15931
Turk J Obstet Gynecol 2019;16:72-5

Cadaveric anatomy and dissection in surgical training

Cerrahi eğitimde kadavrada anatomi ve disseksiyon
İlker Selcuk1, Ilkan Tatar2, Emre Huri3
1University of Health Sciences, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
2Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
3Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey

Abstract
Detailed knowledge of anatomy is an essential part of surgical practice. However, there are many drawbacks in anatomy education that make many residents
feel inadequate when they start performing surgeries. Cadaveric dissection courses aim to close the gap between the anatomic knowledge and surgical
practice. This review focuses on the role of cadaveric dissection on surgical education, and additionally states the panel decision of the Surgical Anatomy
and Technologies Association on the proper use of cadavers
Keywords: Anatomy, surgery, education, cadaver, gynecology

Öz
Cerrahi pratiğin en önemli parçası detaylı bir anatomi bilgisidir. Ancak anatomi eğitiminde birçok engel ve eksiklik bulunmaktadır, ve birçok cerrahi
asistanı cerrahi prosedürleri uygularken yetersizlik hissetmektedir. Diğer bir açıdan, kadavra kursları anatomik bilgi ve cerrahi pratik arasında oluşmuş
olan bu boşluğu kapatmayı hedeflemektedir. Bu derleme, kadavra disseksiyonunun cerrahi eğitimdeki rolüne odaklanmakla beraber; Cerrahi Anatomi ve
Teknolojileri Derneği’nin kadavraların uygun kullanımı ile ilgili panel kararını da içermektedir.
Anahtar Kelimeler: Anatomi, cerrahi, eğitim, kadavra, jinekoloji

Introduction data through visualization of real anatomic structures.

Additionally, by practicing on cadavers they touch and feel
This review covers the concept of cadaveric dissection in terms
of teaching anatomy and post-graduate surgical training. the anatomic relations more efficiently(3). Owing to the role of
cadaveric dissection in generating a three-dimensional (3D)
The role of cadaveric dissection in teaching anatomy
perspective, and providing an easy way of understanding
Cadaveric dissection has been the main teaching modality and recalling anatomic structures, the literature indicates
in anatomy education since the ancient times. In the 3rd that cadaveric dissection is one of the most powerful ways of
century before Christ, the first human cadaveric dissections
teaching topographic and regional anatomy(1,4).
were performed in Greece by Herophilus of Chalcedon and
Recently, there has been a trend shift in modern anatomy
Erasistratus of Chios to understand the whole body from the
education, and many novel options are used in teaching
viewpoint of anatomy and physiology. However, religious and
moral attitudes and taboos towards physicians and medical anatomy. Cadaveric dissection and didactic lessons with
schools had many detrimental effects on the scientific value atlas images constitute the traditional methods; however,
of cadaver-based education(1). 3D simulation technologies, virtual/augmented reality, 3D
Cadaveric dissection is the traditional way of teaching anatomy printed materials, simulation/training models, and radiology-
after theoretical lessons and discussions on the atlas images(2). based comparative illustrations form the new methodologies
Medical students gain knowledge and strengthen theoretical in current anatomy education(5).

Address for Correspondence/Yazışma Adresi: İlker Selcuk, MD,

University of Health Sciences, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
Phone: +90 530 201 05 46 E-mail: [email protected] ORCID ID: orcid.org/0000-0003-0499-5722
Received/Geliş Tarihi: 16.10.2018 Accepted/Kabul Tarihi: 24.12.2018
©Copyright 2019 by Turkish Society of Obstetrics and Gynecology
Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House.

72
Selçuk et al. Cadavers in surgical education Turk J Obstet Gynecol 2019;16:72-5

Cadaveric dissection and post-graduate surgical education structures was also studied for transvaginal tape and
Post-graduate anatomy education is the core praxis in sacrospinous ligament fixation operations in urogynecology
improving surgical and technical knowledge for surgery literature(15,16).
residents. Simulation-based education with hands-on courses Additionally, the complex structure of pelvic anatomy and the
and cadaveric dissections focus on a detailed practice pathway of the ureter were also demonstrated in cadaveric
of surgical procedures prior to live patient operations, studies for surgical education(17-19). Soft-preserved cadavers,
consequently an increase in confidence levels and surgical which are prepared using phenol, alcohol, and glycerol,
skills of residents will be noticed(6). Nevertheless, cadaveric were used by Barton et al.(20) during a gynecologic oncology
dissection is not the sole method of teaching anatomy and cadaveric course, and the need of such a cadaveric anatomy
it should be complemented by other innovative educational education during gynecologic oncology fellowship was the
tools. In this way, medical students and residents will be better objective result of the end-course evaluation.
equipped and well prepared for future medical activities(7). In addition, management of complications is a major
The problem beyond the inadequacy in anatomy education requirement that a resident needs to learn during the surgical
for surgery residents gave rise to the wide use of cadaveric training period; however, it is not easy to observe these
courses in many surgical disciplines. Giving the opportunity kinds of cases all the time. Cadaveric courses can mimic
to residents to attend these cadaveric courses will improve complications through simulations and this yields a higher
the educational quality during the first steps of learning practice level and competency for less common procedures
surgical procedures by raising self-confidence and better and real-life conditions(21).
surgical skills(8). In practical obstetrics, cadaveric education increased the
ability to manage surgical cases where a serious episiotomy
Cadaveric courses in obstetrics-gynecology and other
surgical disciplines tear or a massive peripartum bleeding occurred(22-24).
Minimally invasive gynecology, with the advantage of video
Cadaveric dissection under the supervision of senior surgeons
recording, especially in the laparoscopic technique, is a well-
and anatomists will develop a practical competency in the
known surgical practice to popularize the surgical approach
field of minimally invasive surgery, gynecology, gynecologic
and maneuvers to a widespread population, and this is also
oncology, and urogynecology, even if in obstetrics, and also
valid for teaching and demonstrating anatomic structures.
for the management of complications(9).
Cundiff et al.(25) evaluated the effectiveness of laparoscopic
Sharma et al.(10) reported the positive effect of procedure-
cadaveric dissection after starting the residency program
oriented cadaveric courses, which target teaching specific
of obstetrics and gynecology to overcome the deficiencies
operations to improve operative confidence and surgical
in anatomy education; the course produced satisfactory
technique. Some advanced surgical procedures could be
results for the participants and also allowed video recording,
observed or performed for the first time at the cadaveric
which could spread the educational materials to non-active
courses, which deeply enhance anatomic knowledge and
participants.
may also provide a higher level of autonomy to perform
Other surgical branches also benefit from cadaveric courses;
procedures independently(6).
residents, fellows, junior surgeons, and new consultants
Post-course surveys showed that improvements in surgical
skills, which are transferrable to the operating room, were gain experience and improve skills with confidence.
essentially maintained by cadaveric dissections(11) and Lim Cadaveric courses are also the approved method of surgical
et al.(8) showed that the best improvements were observed education to share knowledge in brain surgery, plastic
in hysterectomy and salpingo-oophorectomy procedures surgery, orthopedics, general surgery, urology, vascular
for gynecology practice. Both basic and advanced surgical surgery, and other branches. Cadaveric courses will lead to
procedures can be performed on cadavers and the use of fresh improvement of surgical outcomes by means of identifying
frozen cadavers instead of traditional embalmed ones make it proper anatomical landmarks, practicing more without any
easy to learn the general objectives of a surgical operation in stress of the operation room in a comfortable environment,
which a special and tailored practice is needed(12). Simulation and teaching the basis of a new modification in a surgical
of surgical scenarios, identifying the steps of new techniques, approach(26-30).
and teaching the tips and tricks of advanced surgical Panel decision on the “Ethical and Proper Use of Cadavers
procedures are effectively performed by using fresh frozen in Surgical Education”
cadavers for postgraduate surgical education. Surgical Anatomy and Technologies Association (SATA)
Previously, a newer surgical method used in urogynecology organized a panel titled “Ethical and Proper Use of Cadavers
practice, transobturator tape procedure, was widely discussed in Surgical Education” during the First National Anatomy and
in cadaveric illustration studies(13,14). Safe implementation Cadaveric Dissection Symposium of SATA, which was held
of surgical procedures with regard to vascular and neural at Kars, Turkey, in March 2018. More than 50 participants
73
Turk J Obstet Gynecol 2019;16:72-5 Selçuk et al. Cadavers in surgical education

attended this interactive session, which was conducted by Authorship Contributions

three mentors (EH, IT, IS) who were proficient in surgery Concept: İ.S., Design: İ.S., Data Collection or Processing: İ.S.,
and anatomy. The role of cadaveric dissection in surgical İ.T., Analysis or Interpretation: İ.S., E.H., Literature Search:
education was discussed in many aspects. İ.S., Writing: İ.S., İ.T.
The final decisions on the Ethical and Proper Use of Cadavers Conflict of Interest: No conflict of interest was declared by
in Surgical Education: the authors.
-The scientific committee of cadaveric courses should be Financial Disclosure: The authors declared that this study
consisted of phyicians and anatomists, a multidisciplinary/ received no financial support.
advisory board.
-Cadaveric courses without the integration of anatomy References
departments and anatomists will give harm to an effective 1. Ghosh SK. Human cadaveric dissection: a historical account from
education. ancient Greece to the modern era. Anat Cell Biol 2015;48:153-69.
-Dissection subgroups will improve the surgical education 2. Ahmed K, Rowland S, Patel V, Khan RS, Ashrafian H, Davies DC, et
both for mentors and residents. al. Is the structure of anatomy curriculum adequate for safe medical
practice? Surgeon 2010;8:318-24.
-A certification program should be formed to train the teachers
3. Nwachukwu C, Lachman N, Pawlina W. Evaluating dissection in
of cadaveric surgical education (“teach the teachers”). the gross anatomy course: Correlation between quality of laboratory
-Number of participants per cadaver during the cadaveric dissection and students outcomes. Anat Sci Educ 2015;8:45-52.
dissection courses should be defined according to the aim 4. Winkelmann A. Anatomical dissection as a teaching method in
and tasks of the course to maintain a cost-effective and medical school: a review of the evidence. Med Educ 2007;41:15-22.
educational activity. 5. Hu M, Wattchow D, de Fontgalland D. From ancient to avant-garde: a
-Criteria of a well-designed cadaveric course should be review of traditional and modern multimodal approaches to surgical
anatomy education. ANZ J Surg 2018;88:146-51.
established with respect to the training aim, ethics, and health
6. Kim SC, Fisher JG, Delman KA, Hinman JM, Srinivasan JK. Cadaver-
conditions of the environment. Based Simulation Increases Resident Confidence, Initial Exposure to
-Cadaveric dissection laboratories should be high quality Fundamental Techniques, and May Augment Operative Autonomy. J
to preserve the health conditions of the participants and Surg Educ 2016;73:e33-e41.
laboratory personnel. 7. Ghosh SK. Cadaveric dissection as an educational tool for anatomical
-A rotation program to anatomy departments should be sciences in the 21st century. Anat Sci Educ 2017;10:286-99.
implemented to surgical residency education to improve 8. Lim CP, Roberts M, Chalhoub T, Waugh J, Delegate L. Cadaveric
anatomic knowledge. surgery in core gynaecology training: a feasibility study. Gynecol
Surg 2018;15:4.
Despite the higher costs of cadavers, if used effectively and
9. Heisler CA. Importance of adequate gross anatomy education: the
properly, by conducting small but meticulous dissections, impact of a structured pelvic anatomy course during gynecology
cadaveric courses will produce successful educational results fellowship. Anat Sci Educ 2011;4:302-4.
in a cost-effective manner. However, measurements of the 10. Sharma G, Aycart MA, Najjar PA, van Houten T, Smink DS, Askari
validity and effectiveness of these gains are lacking during R, et al. A cadaveric procedural anatomy course enhances operative
surgical operations, as such there is a need for further studies competence. J Surg Res 2016;201:22-8.
in this area(31). 11. Ahmed K, Aydin A, Dasgupta P, Khan MS, McCabe JE. A novel cadaveric
simulation program in urology. J Surg Educ 2015;72:556-65.
Conclusion 12. Jansen S, Cowie M, Linehan J, Hamdorf JM. Fresh frozen cadaver
workshops for advanced vascular surgical training. ANZ J Surg
In conclusion, to gain surgical skills, experience, and 2014;84:877-80.
confidence before performing a procedure on a live patient, 13. Bonnet P, Waltregny D, Reul O, de Leval J. Transobturator vaginal
hands-on cadaveric courses should be an integrated part of tape inside out for the surgical treatment of female stress urinary
surgical education during residency and the post-graduate incontinence: anatomical considerations. J Urol 2005;173:1223-8.
14. Zahn CM, Siddique S, Hernandez S, Lockrow EG. Anatomic
period. Fundamentally, these courses should be planned
comparison of two transobturator tape procedures. Obstet Gynecol
under the supervision of an advisory board consisting of both
2007;109:701-6.
surgeons and anatomists with limited numbers of participants 15. Neuman M, Masata J, Hubka P, Bornstein J, Martan A. Sacrospinous
to allow each attendee achieve the final goals of the course. ligaments anterior apical anchoring for needle-guided mesh is a safe
option: a cadaveric study. Urology 2012;79:1020-2.
Acknowledgement
16. Masata J, Hubka P, Martan A. Pudendal neuralgia following
Special thanks to the board committee of Surgical Anatomy transobturator inside-out tape procedure (TVT-O)--case report and
and Technologies Association. anatomical study. Int Urogynecol J 2012;23:505-7.
17. Nakamura M, Fujii T, Imanishi N, Jinzaki M, Yamada M, Kuribayashi
Ethics S, et al. Surgical anatomy imaging associated with cervical cancer
Peer-review: Internally peer-reviewed. treatment: A cadaveric study. Clin Anat 2014;27:503-10.
74
Selçuk et al. Cadavers in surgical education Turk J Obstet Gynecol 2019;16:72-5

18. Barksdale PA, Brody SP, Garely AD, Elkins TE, Nolan TE, Gasser RF. 2013;42:184-90.
Surgical landmarks of the ureter in the cadaveric female pelvis. Clin 25. Cundiff GW, Weidner AC, Visco AG. Effectiveness of laparoscopic
Anat 1997;10:324-7. cadaveric dissection in enhancing resident comprehension of pelvic
19. Kraima AC, Derks M, Smit NN, van de Velde CJ, Kenter GG, DeRuiter anatomy. J Am Coll Surg 2001;192:492-7.
MC. Careful Dissection of the Distal Ureter Is Highly Important in 26. Martin KD, Patterson DP, Cameron KL. Arthroscopic Training
Nerve-sparing Radical Pelvic Surgery: A 3D Reconstruction and
Courses Improve Trainee Arthroscopy Skills: A Simulation-Based
Immunohistochemical Characterization of the Vesical Plexus. Int J
Prospective Trial. Arthroscopy 2016;32:2228-32.
Gynecol Cancer 2016;26:959-66.
20. Barton DP, Davies DC, Mahadevan V, Dennis L, Adib T, Mudan 27. Matsuo S, Baydin S, Gungor A, Middlebrooks EH, Komune N,
S, et al. Dissection of soft-preserved cadavers in the training of Iihara K, et al. Prevention of postoperative visual field defect after
gynaecological oncologists: report of the first UK workshop. Gynecol the occipital transtentorial approach: anatomical study. J Neurosurg
Oncol 2009;113:352-6. 2018;129:188-97.
21. Hammond I, Taylor J, Obermair A, McMenamin P. The anatomy 28. Ali S, Ibrahim A. Course Review: Birmingham and Coventry
of complications workshop: an educational strategy to improve Hand and Forearm Cadaveric Dissection Course. Ann Plast Surg
the training and performance of fellows in gynecologic oncology. 2018;80:596-7.
Gynecol Oncol 2004;94:769-73. 29. Acar HI, Kuzu MA. Perineal and pelvic anatomy of extralevator
22. Kerbage Y, Debarge V, Lucot JP, Clouqueur E, Rubod C. Simulation abdominoperineal excision for rectal cancer: cadaveric dissection.
training to teach postpartum hemorrhage surgery to residents. Eur J
Dis Colon Rectum 2011;54:1179-83.
Obstet Gynecol Reprod Biol 2016;201:27-30.
30. Ozcan S, Huri E, Tatar I, Sargon M, Karakan T, Yagli OF, et al.
23. Selcuk I, Yassa M, Tatar I, Huri E. Anatomic structure of the internal
iliac artery and its educative dissection for peripartum and pelvic Impact of cadaveric surgical anatomy training on urology residents
hemorrhage. Turk J Obstet Gynecol 2018;15:126-9. knowledge: a preliminary study. Turk J Urol 2015;41:83-7.
24. Emmanuelli V, Lucot JP, Closset E, Cosson M, Deruelle P. 31. Anastakis DJ, Regehr G, Reznick RK, Cusimano M, Murnaghan J,
[Development and assessment of a workshop on repair of third and Brown M, et al. Assessment of technical skills transfer from the bench
fourth degree obstetric tears]. J Gynecol Obstet Biol Reprod (Paris) training model to the human model. Am J Surg 1999;177:167-70.

75