Ex-vivo porcine organs with a circulation pump are effective for teaching hemostatic skills

Simulation training for surgical skills has become essential around the world. Many methods including dry laboratories, simulators, cadavers, and live tissues have been used for basic surgical skill training, open surgery training, and laparoscopic training [1]. To improve trauma surgery education, many educational training courses have been developed. Specifically, many simulation courses such as Advanced Trauma Operative Management, Definitive Surgical Trauma Care, and Advanced Surgical Skills for Exposure in Trauma have been held around the world [2-7].Among the various possible approaches, live animal training may be most suitable for teaching hemostatic skills [1]. However, these courses are expensive and it is difficult to provide repetitive training because they utilize live animal models necessitating general anesthesia, as well as much time and effort. Recently, the use of live animals is decreasing in surgical training. The validity of using a simulated model instead of live animals has been validated for chest tube placement and cricothyrotomy [8]. In addition, it is critically important to adopt the 3R approach to the use of animal models, including Reduction, Refinement and Replacement, originally described in 1959 [9].Simulation training programs may not be suitable for certain kinds of training because the bleeding encountered is not similar to live animals. Ex-vivo training as a type of simulation for surgical education is a less realistic model of hemorrhage than a live animal. However, such courses may be relatively inexpensive and allow repetitive training [1].Recently, with fewer opportunities to participate in live animal training due to economic and ethical aspects, and limited trauma operative experience during training, residents may not be able to learn adequate hemostatic skills in clinical trauma situations alone [10]. In order to improve the competency of residents in basic hemostatic skills in the trauma setting, we created this realisti