UPDATE: RANZCOG has now ended their plans to use live sheep to train on at their upcoming conference!
After hundreds of our supporters sent a message to RANZCOG and/or signed the petition asking RANZCOG to make the right decision, they have announced that they will be cancelling the workshop that involved using live sheep for laparoscopic training.
Thank you so much to the many people who sent an online message and signed the petition. Enough people sent a message for RANZCOG to realise how important this is.
Together we did it — Live sheep will no longer be used to train on at the upcoming RANZCOG conference! We also want to thank RANZCOG for listening to and respecting public opinion.
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More information:
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), was planning to use live sheep to teach surgeons how to do gynaecological surgeries on live sheep during the Pre-Meeting Workshops at their Annual Scientific Meeting, despite the existence of better and more humane methods.
We were concerned for two main reasons: for the well-being of future human patients, and the wellbeing of the sheep they are performing surgery on.
We reached out to RANZCOG to find out if they had considered using one of the many viable non-animal based methods that currently exist instead. Their response was to remove all reference to the sheep from their website.
We then contacted the RANZCOG Board, Council and the Conference Organising Committee members urging them to stop their plans to use live sheep and use a better, more humane method instead.
We received a disappointing response, RANZCOG was still planning on going ahead with their plans to use live sheep to train obstetricians and gynaecologists at their upcoming laparoscopic training workshops being held at Middlemore Hospital in Auckland on the 27th and 28th of October. They must have been embarrassed about it because they then removed all mention of the laparoscopic workshop from the annual scientific meeting programme!
NZAVS had even offered to help source alternative equipment that could be used instead and could train the students better.
We then started inviting our wonderful supporters to send an online message (see the full letter below) to RANZCOG, urging them to end their plans to use live sheep and instead use one of the more scientifically sound and humane options.
At the same time, an online petition was set up to help send the message to RANZCOG.
Full letter sent to RANZCOG by many of our supporters:
Dear RANZCOG,
I am sending you this email because I am concerned about your organisation’s use of live sheep for laparoscopic training during the Annual Scientific Meeting being held at the end of October in Auckland. I am troubled for two main reasons: for the well-being of future human patients, and the wellbeing of the sheep you are performing surgery on.
I am concerned that during the laparoscopic training workshop the lack of repetition and independent assessment may have a detrimental impact on the trainees. There are many laparoscopic box trainers and Virtual Reality simulators that would allow your trainees to repeatedly attempt new surgical skills, and these training tools can objectively assess the trainee’s performance. This data could be used to ensure the trainee is improving, and compare their performance with others within the cohort.
The independent nature of these assessments also has the advantage of ensuring that only the best surgical techniques are conveyed throughout the training. Preventing the transmission of poor surgical practice is surely in the best interest of patients.
The human cadaver model developed by Aboud, Suarez, Al-Mefty and Yasargil in 2004 would more accurately simulate surgical procedure on a human patient than an anaesthetised sheep. This model was developed over a decade ago; why is your organisation continuing to rely on archaic and inhumane animal models?
My other concern is for the welfare of the sheep you are planning on performing surgery on. As medical doctors, scientists, and researchers I would expect you already have a high respect for life. The Animal Welfare Act (1999) stipulates that one of the primary purposes of this piece of New Zealand Legislation is to promote the replacement of animals with non-sentient teaching apparatuses.
NZAVS have already sent you appropriate training devices which do not use sentient beings, and evidence showing researchers in peer-reviewed academic publications illustrating why these models are more beneficial and appropriate for laparoscopic training.
I am concerned that despite the existence of human-relevant teaching methods you are going ahead with the use of anaesthetised animals.
I believe that human patients deserve the highest standard of care, and I also believe that your organisation should adhere to New Zealand Legislation to ensure your medical and ethical practices meet the highest standards.
I urge your organisation to reconsider their use of anaesthetised sheep and instead adopt one of the human-relevant training methods NZAVS has outlined for you.
Regards,
One of our amazing supporters
Why they needed to end their plans to use live sheep for training:
A laparoscopic training workshop using live sheep may have a detrimental impact on the trainees due to the lack of repetition and independent assessment. There are many laparoscopic box trainers and Virtual Reality simulators that would allow trainees to repeatedly attempt new surgical skills, and these training tools can objectively assess the trainee’s performance. This data could be used to ensure the trainee is improving, and compare their performance with others within the cohort.
The independent nature of these assessments also has the advantage of ensuring that only the best surgical techniques are conveyed throughout the training. Preventing the transmission of poor surgical practice is surely in the best interest of patients.
Our other concern was for the welfare of the sheep. The Animal Welfare Act (1999) stipulates that one of the primary purposes of this piece of New Zealand Legislation is to promote the replacement of animals with non-sentient teaching apparatuses.
Below we have listed some of the many appropriate training devices which do not use sentient beings, and researchers in peer-reviewed academic publications have illustrated why these trainers are more beneficial and appropriate for laparoscopic training.
We believe that human patients deserve the highest standard of care, and we also wanted RANZCOG to adhere to New Zealand Legislation to ensure their medical and ethical practices meet the highest standards!
Available Human-Based Models for Laparoscopic Surgery
Box Trainers
There are many box trainers on the market, designed specifically for the purposes of effective training for laparoscopic surgery. These models are affordable and are effective at helping surgeons acquire basic laparoscopic skills.1Dhariwal et al. promote the use of box trainers based on the results of their 2007 study, where they found that intensive courses using box trainers were highly effective in imparting laparoscopic skills to surgical trainees.2They also argue that:
The advantage of box-training for objective evaluation of basic skills is twofold. First, the scenario for testing is easily reproducible. The performance is not biased by the variations in anatomy or physiologic response found in animals. The exact same test can be repeated in identical fashion at any location at any time. Second, the equipment is inexpensive, reusable and easy to set up quickly without an experienced staff.3
There are many box trainers currently available, we have included a selection below:
https://simulab.com/collections/laptrainer-with-simuvision-system
https://www.eosurgical.com/collections/simulators-individual
https://laparosimulators.com/individuals/
https://www.fls-products.com/products/fls-all-in-one-trainer-system
As Dhariwal et al. have explained, laparoscopic box trainers have an advantage over anaesthetised animal models as the testing scenario is highly reproducible and data is collected.4 With box trainers, trainees are able to rehearse the surgical procedure many more times than using animal would allow for, and data is collected to determine whether the trainee has improved.
Virtual Reality Training
Virtual Reality laparoscopic simulators offer many of the same benefits as box trainers. As McCloy and Stone note, in simulators difficulty, can be increased or decreased, performance can be measured, and rich data is compiled for later analysis.5 Virtual Reality trainers are also able to simulate full surgical procedures.6 In both clinical trials and systematic reviews, researchers have found significant evidence to promote VR training for laparoscopic surgery as skills were vastly improved among trainees.7 Larsen et al. particularly advocate the use of VR trainers for surgical gynaecology.8
Cadaver Model
Human cadaver models are also used for training laparoscopic surgeons. This model has the obvious advantages of anatomy and tissue consistency.9 The drawback of cadaveric models is, of course, the lack of blood flow. Aboud et. all developed a cadaveric model in 2004 that mimics the vascular system by filling the model with artificial blood and inducing pulsation by connecting an intra-aortic balloon pump to the cannulated artery.10 This type of laparoscopic trainer provides a representative anatomical model while also displaying life-like surgical simulation.11
A 2015 study advocates increasing access to laparoscopic trainers for trainees and encourages the use of simulator data to determine whether trainees are ready for surgery.12 Burden et al. argue that simulation of surgery on a laparoscopic box trainer or VR trainer not only greatly improved the technical skills of trainees, but also non-technical skills; the authors surmised that the repetitive nature of the training allowed surgeons to become more automated, and therefore able to focus to a greater degree on other theatre skills.13 Mohtashami, Dadelszen, and Allaire have argued that the ‘apprentice’ model of training is inadequate as poor surgical skills can be easily passed from mentor to mentee.14 These authors note that trainers that can independently assess skills have the advantage of being objective, and encourage trainers to adopt simulators:
Under the apprentice method, translating the planned to the learned is very much mentor dependent. However, with competency-based education using a variety of tools including surgical simulators and with correctly implemented and valid assessment tools to drive learning, greater confluence of the planned and the learned curricula can occur. More competent surgeons will, therefore, emerge from such programs.15
1 Schrueder et al. (2011) p. 208.
2 Dhariwal et al. (2007) accessed online here: www.ncbi.nlm.nih.gov/pmc/articles/PMC2980722/
3 Ibid.
4 Ibid.
5 McCloy and Stone (2001) p. 913.
6 Schrueder et al. (2011). P. 208.
7 Grantcharov et. al. (2003) p. 146; Larsen et al. (2012) p. 1015.
8 Larsen et al. (2012) p. 1015.
9 Yiannakopoulou et al. (2015) p. 61.
10 Aboud et al. (2004) p. 501.
11 Ibid., p. 506.
12 Burden et al. (2016) p. 239.
13 Ibid., p. 238.
14 Mohtashami, Dadelszen and Allaire (2011) accessed here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183557/
15 Ibid
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