Simulated management of inferior vena cava injury during robotic paraaortic lymphadenectomy utilizing the porcine model


Injury of the inferior vena cava is an infrequent but serious complication of paraaortic lymphadenectomy. Training in the management of this injury might be enhanced through animate simulation. Our objective was to assess a simulated animal model for training in intraoperative management of inferior vena cava injury in the context of robotic paraaortic lymphadenectomy. We used a female domestic pig to create an injury of the inferior vena cava, which was then managed two ways with robotically assisted surgery. Edited videos of the two models were assessed by 32 senior learners and 23 attending faculty. The assessments included key competencies and domains of fidelity. A scale of poor, fair, or good was utilized. The injury and management simulated those seen in humans, both anatomically and surgically, although deficiencies were noted. Specifically, a reduced rapidity of bleeding and a related greater ease of control contributed to lower ratings for some aspects of fidelity. Fidelity and addressing the key competency of suture repair also received some lower ratings, particularly from vascular surgeons and their trainees. The porcine model for simulation of inferior vena cava injury during robotically assisted paraaortic lymphadenectomy may be useful for training purposes.

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This study was funded by USF Center for Advanced Medical Learning and Simulation.

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Correspondence to Mitchel S. Hoffman.

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Dr. Mitchel Hoffman declares that he has no conflict of interest. Dr. Nadim Bou Zgheib declares that he has no conflicts of interest. Dr. Murray Shames declares that he has no conflict of interest.

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All applicable international, national, and institutional guidelines for the care and use of animals were followed. All procedures were performed in accordance with the ethical standards of the University of South Florida Institutional Animal Care and Use Committee.

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Hoffman, M.S., Zgheib, N.B., Young, C. et al. Simulated management of inferior vena cava injury during robotic paraaortic lymphadenectomy utilizing the porcine model. J Robotic Surg 14, 649–653 (2020).

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  • Porcine
  • Robotic
  • Vena cava injury