BACKGROUND: Modular training has been established as an educational tool in colorectal and urology surgery for the last 5 years. This modular operative approach is a graduated step-wise method to learn a complex procedure allowing the trainee to develop their skills irrespective of prior experience. The feasibility and safety of modular training in organ procurement surgery is yet to be established. Over the past 5 years in our institution, liver procurements have been performed by transplant fellows applying a modular training approach. This study assessed the efficacy of modular organ procurement surgery training on organ safety and proficiency gain in transplant fellows.

METHODS: This is a single institution retrospective review of 304 consecutive liver retrievals. Our standard retrieval technique involves more warm dissection, including complete liver and IVC mobilization. This was divided into 5 operative training modules: 1-Major vessels dissection, 2-Liver mobilization, 3-Hepatoduodenal ligament dissection, 4- Cannulation/flushing and 5-Cold dissection. During each procurement, the 1^st year fellow performed only the operative steps that corresponded to his acquired skill level. The mentor (2^nd year fellow) performed the remaining part.

RESULTS: Between July 2010 and December 2015, 248 consecutive liver procurements were performed by our 6 fellows who are in ASTS- accredited abdominal organ transplant fellowship program, including 36 (15%) Donations after Cardiac Death (DCD). 2^nd year fellows served as primary surgeon in 49 cases (20%) versus 199 cases (80%) where the 1^st year fellow was totally independent surgeon. A median of 7 (range 6-10) and of 19 (range 11- 38) total procurements (Donations after Brain Death (DBD) and DCD) were required before the 1^st year fellows gained proficiency and independence in DBD and DCD respectively (p<0.05). There was no graft loss due to technical error during the study period. One missed right replaced hepatic artery required reconstruction after reperfusion.

CONCLUSION: A modular operative training program is a safe and viable alternative offering continuity of technical expertise and evaluation of liver allografts. Additionally, technique standardization in liver procurement shortens the time to proficiency gain with minimal morbidity.

CITATION INFORMATION: Al Hasan I, Sharma H, Tun-Abraham M, Quan D. A Multi-Modular Approach for Training in Liver Procurement Accelerates Proficiency Gain. Am J Transplant. 2016;16 (suppl 3).

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