# Creating a sustainable and inexpensive dry animal training model for liver surgery in low- and middle-income countries

## TL;DR

A low-cost bovine liver model is developed to train surgeons in liver surgery, aiming to improve access to hepatobiliary surgical training in low- and middle-income countries.

## Contribution

The novel contribution is a sustainable, inexpensive bovine liver training model for hepatobiliary surgery in resource-limited settings.

## Key findings

- A bovine liver model with simulated blood flow was successfully used to perform a partial hepatectomy.
- The model allowed for practicing bleeding control techniques like the Pringle maneuver and suture ligation.
- The procedure was completed in one hour with 700 mL of estimated blood loss, demonstrating practicality for training.

## Abstract

The growing global demand for surgical simulation training is particularly challenging in low- and middle-income countries (LMICs), where access to advanced technology is limited. Despite increasing demand for these services, hepatobiliary surgical training in LMICs is constrained by a need for more training facilities and experts. We, therefore, designed a feasible, cost-effective liver surgery training model using bovine liver. We hypothesise that this sustainable model can significantly enhance surgical training in LMICs.

A bovine liver was procured from a local slaughterhouse, with careful preservation of its vascular structures. The specimen was transported to the Muhimbili University of Health and Allied Sciences’ Laboratory and prepared using a back-table technique. Major vessels were connected to a water flow system, simulating near-physiological central venous and arterial pressures. These parameters were adjusted to mimic real-time effects, creating a training environment similar to that of an actual surgical candidate.

A partial hepatectomy was successfully performed using the crush-clamping technique. Hydrodynamic alterations and simulated bleeding were effectively managed through the Pringle maneuver, suture ligation and stick-tying techniques. The procedure was completed in approximately 1 hour, with an estimated blood loss of 700 mL.

An inexpensive, ethical and sustainable bovine liver model was designed for surgical training. This simulation can be easily replicated in training facilities across LMICs to enhance surgical education, particularly in hepatobiliary surgery.