Like it or not, the use of live animals in surgical training saves lives.
![It is far from ideal that we should use animals in this way, says surgeon John Cunningham, "but until a completely ...](/web/20160729065339im_/http://www.theage.com.au/content/dam/images/g/o/e/t/f/4/image.related.articleLeadwide.620x349.gobgug.png/1461989348651.jpg)
There are many qualities of the highly trained surgeon that are easy to identify. We must be sensitive, compassionate, intelligent, proficient and, of course, technically skilled. When a patient is walking the line between life and death, however, it is the latter qualities that are most important.
If injured on the suburban or military battlefield, it may be myself or one of my trauma colleagues who have to stem the flow of blood from your circulation, create an airway for your lungs, or relieve the pressure inside your skull. I hope you never have to experience that trauma care, but for those of you who need it, how well do you want your surgeon to be trained?
![When the life of a human being depends on your skills, you ensure that your skills are as honed as they can be.](/web/20160729065339im_/http://www.theage.com.au/content/dam/images/g/o/e/1/l/4/image.related.articleLeadwide.620x349.gobgug.png/1461989348651.jpg)
More than 10 years ago, when I was training to become a surgeon, I attended a course that was designed specifically to train us in managing life-threatening catastrophic trauma injuries, such as stabbings, gunshot injuries and car accidents. Called the Definitive Surgical Trauma Care course, and taught worldwide, it was several days of didactic teaching, discussion of case management, and simulation using both mannequins and animals such as pigs – alive, but very heavily anaesthetised and completely unaware and unconscious, under the supervision of a veterinary anesthetist.
Just like human trauma cases, the animals were used to demonstrate injuries such as stabbings to the chest and the abdomen, or a crushed windpipe, and from them we learnt the skills to save lives. Under the time pressure of a ruptured blood vessel, for example, we learnt the skills to safely but quickly open the chest cavity, to stem the flow of blood, and to successfully save the patient.
When placed under that sort of duress, your world contracts, your thoughts become calm and clarified, your hands manoeuvre with bold and authoritative strokes, and your training is then as realistic as it can ever possibly be.
The environment of having a warm, breathing, bleeding animal in front of us made it feel real – in my mind the animal became human and it was my responsibility to save it. When a beating heart is in your hands, it does not belong to a human or an animal – you just want to keep it going.
![A new study has found huge variation in the cost of prostate surgery, particularly between states.](/web/20160729065339im_/http://www.theage.com.au/content/dam/images/g/o/e/1/k/n/image.related.articleLeadNarrow.300x0.gobgug.png/1468545569467.jpg)
It is human nature to feel for the animals that you are about to learn from, that are going to give up their lives for your education. They were treated with utmost respect. Surgeons are not barbarians, after all – we are in the business of saving lives, and no one would have proceeded if there was any concern that the animal was suffering.
The tone of the laboratory was as sombre as a church. Nobody in the room enjoyed watching the animals being injured, rather we saw it as a necessary part of our training. When the life of a human being depends on your skills, you ensure that your skills are as honed as they can be.
It is a natural reaction for anyone, particularly surgeons who are committed to saving lives, to react in a negative way upon experiencing this kind of simulation, but it is by far the most realistic and appropriate way to learn these skills at that point of training.
One of my surgical colleagues, Jill Tomlinson, expressed her opinion recently that mannequins, cadavers and tissue from dead animals could and should replace the use of live animals in such training courses. A human cadaver can teach anatomical layout and technical procedure, but lacks feedback about tissue tension, blood pressure and, for example, success in sealing a burst vessel.
A mannequin teaches process and stepwise procedures, but lacks the feel of real tissue. Basic procedures such as cannulation can begin to be taught using mannequin simulators, but it is only by learning on Shylock's pound of flesh that one can learn the sensory feedback of a procedure. When pilots train in simulators, airlines spend millions to recreate the cockpit environment as realistically as possible.
It may appear shocking to many outside the surgical realm, but the most realistic simulator for surgical trauma is an animal with a beating heart and anatomy similar to a human. The next step in training after this is taking the controls of the real thing – and that could be you.
I understand the concerns of animal activists. It is far from ideal that we should use animals in this way, but until a completely lifelike simulator is invented that can mimic humans as closely as animals do, we are obliged to train ourselves in this way. We owe it to our trauma patients.
It may seem grotesque at first, but if you want your trauma surgeon to train in the most realistic manner, at the sharp end of surgical trauma care, then these animals will possibly one day help save your life.
John Cunningham is an orthopaedic spinal surgeon at Royal Melbourne Hospital and the Epworth Richmond.
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