title: History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method.
abstract: Traditionally, surgical training meant on-the-job training with live patients in an operating room. However, due to advancing surgical techniques, such as minimally invasive surgery, and increasing safety demands during procedures, human cadavers have been used for surgical training. When considering the use of human cadavers for surgical training, one of the most important factors is their preservation. In this review, we summarize four preservation methods: fresh-frozen cadaver, formalin, Thiel's, and saturated salt solution methods. Fresh-frozen cadaver is currently the model that is closest to reality, but it also presents myriad problems, including the requirement of freezers for storage, limited work time because of rapid putrefaction, and risk of infection. Formalin is still used ubiquitously due to its low cost and wide availability, but it is not ideal because formaldehyde has an adverse health effect and formalin-embalmed cadavers do not exhibit many of the qualities of living organs. Thiel's method results in soft and flexible cadavers with almost natural colors, and Thiel-embalmed cadavers have been appraised widely in various medical disciplines. However, Thiel's method is relatively expensive and technically complicated. In addition, Thiel-embalmed cadavers have a limited dissection time. The saturated salt solution method is simple, carries a low risk of infection, and is relatively low cost. Although more research is needed, this method seems to be sufficiently useful for surgical training and has noteworthy features that expand the capability of clinical training. The saturated salt solution method will contribute to a wider use of cadavers for surgical training.
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan. shogo@tokyo-med.ac.jp.
authors.forename: Shogo
authors.identifier: http://orcid.org/0000-0003-0302-7658
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan.
authors.forename: Munekazu
authors.initials: M
authors.lastname: Naito
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kawata
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
authors.forename: Ning
authors.initials: N
authors.lastname: Qu
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hatayama
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hirai
authors.affiliation: Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itoh
mesh_terms: D002102:Cadaver; D004501:Education, Medical / Q000379:methods*; D005557:Formaldehyde; D013502:General Surgery / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D009926:Organ Preservation / Q000379:methods* / Q000639:trends; D019188:Organ Preservation Solutions; D012965:Sodium Chloride; D013664:Teaching Materials
chemical_list: D019188:Organ Preservation Solutions; D005557:Formaldehyde; D012965:Sodium Chloride
keywords: Cadaver; Embalming; Formaldehyde; Organ preservation; Solutions; Training techniques