Creating a sustainable and inexpensive dry animal training model for liver surgery in low- and middle-income countries.

Background: The growing global demand for surgical simulation training is particularly challenging in low- and middle-income countries (LMICs), where access to advanced technology is limited. Despite increasing demand for these services, hepatobiliary surgical training in LMICs is constrained by a need for more training facilities and experts. We, therefore, designed a feasible, cost-effective liver surgery training model using bovine liver. We hypothesise that this sustainable model can significantly enhance surgical training in LMICs. Methods: A bovine liver was procured from a local slaughterhouse, with careful preservation of its vascular structures. The specimen was transported to the Muhimbili University of Health and Allied Sciences' Laboratory and prepared using a back-table technique. Major vessels were connected to a water flow system, simulating near-physiological central venous and arterial pressures. These parameters were adjusted to mimic real-time effects, creating a training environment similar to that of an actual surgical candidate. Findings: A partial hepatectomy was successfully performed using the crush-clamping technique. Hydrodynamic alterations and simulated bleeding were effectively managed through the Pringle maneuver, suture ligation and stick-tying techniques. The procedure was completed in approximately 1 hour, with an estimated blood loss of 700 mL. Conclusion: An inexpensive, ethical and sustainable bovine liver model was designed for surgical training. This simulation can be easily replicated in training facilities across LMICs to enhance surgical education, particularly in hepatobiliary surgery.