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Chapters

The content of the E-learning:

Chapter 1 Anatomy

Chapter 2 Preparations

Chapter 3 Thoracophrenicolaparotomy

Chapter 4 Internal examination

Chapter 5 Mobilisation

Chapter 6 Cannulation

Chapter 7 Thoracic organ procurement

Chapter 8 Pancreatectomy

Chapter 9 Hepatectomy

Chapter 10 Nephrectomy

Chapter 11 Final steps

Chapter 12 General Principles

Junior surgeons will benefit the most of the E-learning, although it could serve as a reference source for more senior surgeons as well. Furthermore the owners hope that the content of the E-learning will stimulate further discussion about MOD procurement surgery in order to enhance quality and safety. For this purpose, the forum has been integrated.

Chapter 1 Anatomy

After the lesson, the surgeon masters the essential anatomical knowledge needed during abdominal multi-organ procurement surgery. An emphasis is laid on venous and arterial blood supply of the liver, pancreas, kidneys and its most commonly occuring variations. With this knowledge, the surgeon will be able to find, recognize and access the vascularisation of the abdominal organs. Furthermore this knowledge will aid in decision making on splitting arteries between abdominal organs to allow simultaneous liver and pancreas procurement for transplantation. The surgeon in training will also be able to find and recognize all vascular abnormality concerning vascularization of the kidneys and the ureters.

Chapter 2 Preparations

After the lesson, the surgeon is aware of the importance to accord with the local team, knows which topics should be discussed with the team, which donor and theatre checks should be performed, and how the donor should be positioned, disinfected and draped.

Chapter 3 Thoracophrenicolaparotomy

After the lesson, the surgeon knows the location and extent of the skin incision and understands how to perform the laparotomy and the thoracotomy in such a manner that risk of damage to the internal organs is minimized and maximal exposure is obtained.

Chapter 4 Internal examination

In this lesson the surgeon is trained in applying transplantation criteria on decision making regarding transplantability of indidividual organs.

Chapter 5 Mobilisation

After the lesson, the surgeon knows how to mobilise all abdominal structures by using avascular access routes. The rationale/reason to use avascular access routes to free the abdominal organs is to minimize donor blood loss. “Landmarks” are placed on the blood vessels of each abdominal organ. In this way the final steps can be performed optimally in the non-circulatory phase, when speed is more important and recognisability of structures is reduced. The mobilisation phase is the most extensive phase of the whole procedure, consisting of the following steps: colon & Ileum mobilisation, extended Kocher's manoeuvre , placement of distal aorta ligatures and inferior caval vein ligatures, dissection of the superior mesenteric artery, mobilisation of the left liver lobe, the hepatogastric ligament and the hepatoduodenal ligament.

Chapter 6 Cannulation

After the lesson, the surgeon understands the importance of informing and making clear prior agreements with the procurement operation team and the receiving teams(time of donor heparinization, type of preservation solution, use of unusual medicines). Furthermore, the surgeon understands how to construct the abdominal aorta perfusion and vena cava inferior decompression systems, knows the steps of great abdominal vessels cannulation and decompression and understands how and when to start cold perfusion. Also, the surgeon understands that elapsed time is critical from the moment of starting the cold perfusion.

Chapter 7 Thoracic organ procurement

This chapter is only a single page indicating the moment when thoracic organ procurement will be performed, but does not go into details on this procedure, as the topic of this course is abdominal organ procurement. The abdominal surgeon is made aware of the thoracic organ procurement and the need to synchronize critical steps of the procedures by both teams.

Chapter 8 Pancreatectomy

After the lesson, the surgeon knows the surgical technique of the procurement of the pancreas with the duodenum and the spleen. Pancreas retrieval contains the following steps and the surgeon knows how to perform these steps: dissecting the duodenum, dissecting the stomach, cutting the vessels cranial of the pancreas, dissecting caudal from the pancreas, dissecting the pancreas tail with the spleen, cutting the splenic artery and the superior mesenteric artery (SMA). Also, the surgeon learns how blood vessels that are involved in the blood-supply of both the liver and the pancreas, should be divided between those organs. Instructions on how to deal with different anatomical variations are included not only in this lesson but also in the anatomical chapter of the e-learning.

Chapter 9 Hepatectomy

After the lesson, the surgeon knows that hepatectomy contains the following steps and knows how to complete these steps: cutting the celiac trunk, cutting the Inferior Vena Cava, cutting the diaphragm.

Chapter 10 Nephrectomy

After the lesson, the surgeon knows how the Aorta and Inferior Vena Cava are dissected and allocated to the left and right kidneys and has learned how to free both kidneys and how and where to dissect and cut the ureters. Finally, the surgeon knows how to inspect both kidneys to recognize not only the renal vascularization but also diseases of renal parenchyma.

Chapter 11 Final steps

After the lesson, the surgeon knows how to close the donor body aesthetically optimally, taking in consideration the importance for the kins of a neat scar, as a sign of a respectful and carefully performed procedure. Also, the surgeon has learned how to procure arterial and venous 'tool-kits', how to check, prepare and package the organs, and how to fill out the Quality forms that are used in the Netherlands.

Chapter 12 General Principles

This last chapter contains a single page recapitulating and emphasizing general principles in attitudinal and ethical approaches.

Go to course outline

See also: Accreditation