See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/351589023

The Usefulness of Genelyn® Embalming Method for Gynaecological Surgical

Skill Training: a New Cadaveric Training Model for Laparoscopic Hysterectomy

Article  in  Indian Journal of Surgery · May 2021

DOI: 10.1007/s12262-021-02928-6

CITATIONS READS

0 12

6 authors, including:

Rajasekhar Sssn Dinesh Kumar V

Jawaharlal Institute of Postgraduate Medical Education & Research Jawaharlal Institute of Postgraduate Medical Education & Research
42 PUBLICATIONS   52 CITATIONS    120 PUBLICATIONS   45 CITATIONS   

SEE PROFILE SEE PROFILE

Raveendranath Veeramani
Jawaharlal Institute of Postgraduate Medical Education & Research
45 PUBLICATIONS   146 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Leadership in medical education View project

Curricular reform View project

All content following this page was uploaded by Rajasekhar Sssn on 15 May 2021.

The user has requested enhancement of the downloaded file.

Indian Journal of Surgery
https://doi.org/10.1007/s12262-021-02928-6
LETTER TO EDITOR
The Usefulness of Genelyn® Embalming Method for Gynaecological
Surgical Skill Training: a New Cadaveric Training Model
for Laparoscopic Hysterectomy
S. S. S. N. Rajasekhar 1 & V. Dinesh Kumar 1 & P. Veena 2 & Dilip Kumar Mourya 2 & Latha Chathurvedula 2 &
V. Raveendranath 1
Received: 23 February 2021 / Accepted: 10 May 2021
# Association of Surgeons of India 2021
Dear Editor in Chief, Indian Journal of Surgery,
We present a novel simulation model for surgical skill train-
ing in laparoscopic surgery in gynaecology. Laparoscopy has
become a gold standard for operating benign and certain malig-
nant conditions in gynaecology. However, there is neither a
structured training program nor committed time for learning
and practising the laparoscopic surgical skills during the
gynaecological residency period in many parts of the world
[1]. The learning curve for laparoscopy includes mastering basic
and advanced skills. Virtual computer–based training modules
are available for learning basic laparoscopic skills and have been
found to provide considerable learning gain for the novices [2].
For learning advanced laparoscopic skills, anaesthetised animal
models serve as an authentic tool, owing to its realistic tissue
consistency and hands-on exposure to bleeding management [3].
However, the anatomy of the animal model is different from that
of the humans, which results in a compromise in terms of
* S. S. S. N. Rajasekhar
sekhar5883@gmail.com
V. Dinesh Kumar
dinesh.88560@gmail.com
P. Veena
veenup_2001@yahoo.com
Dilip Kumar Mourya
dilipkm2@gmail.com
Latha Chathurvedula
drlathach@gmail.com
V. Raveendranath
dr_raveendra@rediffmail.com
1
Department of Anatomy, JIPMER, Puducherry, India
2
Department of Obstetrics and Gynaecology, JIPMER,
Puducherry, India
visuospatial skill mastery and skill transfer to patient manage-
ment [3]. This calls for utilising human cadavers for learning
advanced gynaecological laparoscopic skills.
Among the available cadaveric models, fresh frozen ca-
davers are ideal because of the realistic simulation it offers
to surgeons. However, they decompose very quickly after
thawing and are costly to maintain, which does not make them
an ideal tool for training. Moreover, they are suitable only for
a single-day workshop as they start decomposing quickly
once they are thawed. The formalin embalmed cadavers are
not suitable for practising \ laparoscopic surgical skills as the
formalin-fixed tissues become hard, grey, and un-
manoeuvrable. Moreover, it is not possible to create
pneumo-peritoneum because of the non-stretchable nature of
anterior abdominal wall in formalin embalmed cadavers [4].
Soft embalming methods such as Thiel’s and Genelyn® con-
fers softness and flexibility to the tissues. Thiel’s embalming
needs an immersion period of 3 months before the cadavers
can be utilized for skills training. Furthermore, Thiel’s
embalming involves the high cost of chemicals and robust
infrastructure, including a sophisticated immersion tank and
meticulous preparation of the working solution, owing to the
explosive nature of the chemical constituents [5].
Genelyn® is a proprietary Australian fluid where constitu-
ents of it are not revealed by the manufacturer. However, some
of the constituents of the Genelyn® embalming solution re-
ported in the literature 1-methoxy-2-propanol, formaldehyde,
glycerol, methanol, and disodium tetraborate decahydrate
[6–8]. Genelyn®, unlike the conventional formaldehyde
embalming, does not discolour or stiffen the tissues.
Genelyn® maintains tactile fidelity and ability to separate tis-
sue planes [9, 10]. Embalming using Genelyn® is a cheaper
alternative which gives similar results, if not better than
Thiel’s for use in surgical skill training workshops. The cost
of embalming a single cadaver using Genelyn® is much lower
(INR 7500 to 15,000) than the Thiel method (approx. cost of

Fig. 1 The residents of
gynaecology practicing
laparoscopic hysterectomy in
Genelyn®-embalmed cadavers
(GEC)
consumables is INR 35,000, excluding the infrastructure).
Although the Genelyn®-embalmed cadavers (GEC) require
storage in cold chambers at 4° centigrade, they can be used
immediately, without any waiting period. Another advantage
is that the Genelyn® embalming is convenient to
operationalise in a limited resource setting without cost-
intensive investment in infrastructure.
As a pilot study, we have used four GECs for hands-on
training of obstetrics and gynaecology residents (Fig. 1). The
trainees practiced both laparoscopic hysterectomy and radical
hysterectomy by laparotomy. They assessed the viscera such
as the uterus, adnexa, ureter, ovary, urinary bladder, pelvic
blood vessels, and recto-uterine pouch. We asked them to
record their perception in terms of haptic characteristics of
the structures, the similarity in appearance to the real-life,
overall fidelity of the model, and suitability of the cadaver
for its use as a stand-alone learning tool, using a standardised
anonymous Likert scale–based questionnaire. Most of the par-
ticipants strongly agreed that the colour, consistency, tissue
pliability, haptic quality, manoeuvrability, and suture place-
ment were comparable to the in vivo conditions. Similarly,
they documented that the visual fidelity of the organs was
similar to the live cases. The participants opined that the
GEC would be a satisfactory simulation model and felt that
the frequent cycles of training in it shall improve their laparo-
scopic surgical skills.
Earlier, Genelyn® embalming was considered to produce
tissue stiffness and reduced tissue pliability with a difficulty to
separate various tissue planes [6, 7]. However, in our experi-
ence with GEC used for surgical skills training of laparoscopic
and open surgeries, we have obtained good results where the
tissues were soft, pliable, separable, with no change of colour,
Indian J Surg
and no pungent odour. The quality of tissues such as visual
and tactile fidelity and tissue pliability will depend on numer-
ous factors such as the time interval between the death and
embalming, rigor mortis, cause of death, pH status of the
body, and time interval between the death and refrigeration
of the body in the cold storage. Ideally, the time interval be-
tween the death and embalming should be within 6 h of death,
without cold storage, and within 24 h after death, with cold
storage. Meticulous cadaver selection criteria, considering the
factors such as choosing a voluntarily donated body that is
transferred immediately to the cold chamber after the death,
bodies without arterial solution perfusion problems, may be
the reason for the better results with GEC in the present study
and some previous studies by the authors [9, 10].
In conclusion, in our experience, we observed that GECs are
suitable for advanced laparoscopic gynaecological simulation
exercises. Genelyn® is a cheaper and convenient alternative to
Thiel’s method. Hence, GECs may be an excellent tool for
improving surgical skills, and the residents of gynaecology
may benefit from practising advanced laparoscopic procedures
in GEC. More studies may be done to investigate the utility of
GEC in surgical simulation in other surgical specialities.
Author Contribution Conceptualization: RSSSN, LC. Data acquisition:
SG. Data analysis or interpretation: SG, LC, PA. Drafting the manuscript:
RSSSN, SG. Critical revision of the manuscript: SSSN, LC, PA.
Approval of the final version of the manuscript: all authors.
Data Availability This study involves human cadavers that are routinely
dissected for teaching undergraduate students. Hence, the study material
is further utilised for dissection purposes. Study data, including master
charts, are available with the authors.
Code Availability Not applicable.
Indian J Surg
Declarations
Ethics Approval This study involves human cadavers that are routinely
dissected for teaching undergraduate students. All cadavers are procured
on the basis of the Anatomical Act which caters to the supply of human
cadavers meant for teaching and research. The human cadavers are
sourced from voluntary whole-body donations and unclaimed bodies.
Hence, all cadaveric studies have implied consent for research in their
manner of procurement itself and do not need additional consent. This
procedure is currently followed in our institution and we have followed
the same. All procedures performed in studies involving human partici-
pants were in accordance with the ethical standards of the institutional
and/or national research committee and with the 1964 Helsinki declara-
tion and its later amendments or comparable ethical standards.
Consent to Participate This study involves human cadavers that are
routinely dissected for teaching undergraduate students. All cadavers
are procured on the basis of the Anatomical Act which caters to the supply
of human cadavers meant for teaching and research. The human cadavers
are sourced from voluntary whole-body donations and unclaimed bodies.
Hence, all cadaveric studies have implied consent for research in their
manner of procurement itself and do not require additional consent to
participate.
Consent for Publication This study involves human cadavers that are
routinely dissected for teaching undergraduate students. All cadavers are
procured on the basis of the Anatomical Act which caters to the supply of
human cadavers meant for teaching and research. The human cadavers
are sourced from voluntary whole-body donations and unclaimed bodies.
Hence, all cadaveric studies have implied consent for research in their
manner of procurement itself and do not require additional consent for
publication.
Conflict of Interest The authors declare no competing interests.
References
1. Molina MM, Le TH, Delaney H, Weir LF (2019) Development of
in-situ simulation lab for training gynecology residents in basic
laparoscopic and Hysteroscopic Operative Skills. Cureus 11:e4385
View publication stats
2. Alaker M, Wynn GR, Arulampalam T (2016) Virtual reality train-
ing in laparoscopic surgery: a systematic review & meta-analysis.
Int J Surg 29:85–94
3. Enciso S, Díaz-Güemes I, Pérez-Medina T, Zapardiel I, de Santiago
J, Usón J, Sánchez-Margallo FM (2016) Validation of a structured
intensive laparoscopic course for basic and advanced gynecologic
skills training. Int J Gynaecol Obstet 133:241–244
4. Hayashi S, Naito M, Kawata S, Qu N, Hatayama N, Hirai S, Itoh M
(2016) History and future of human cadaver preservation for surgi-
cal training: from formalin to saturated salt solution method. Anat
Sci Int 91:1–7
5. Hammer N, Löffler S, Bechmann I, Steinke H, Hädrich C, Feja C
(2015) Comparison of modified Thiel embalming and ethanol-
glycerin fixation in an anatomy environment: Potentials and limi-
tations of two complementary techniques. Anat Sci Educ 8:74–85
6. Jaung R, Cook P, Blyth P (2011) A comparison of embalming
fluids for use in surgical workshops. Clin Anat 24:155–161
7. Genelyn®. (2010) Material Safety Data Sheet [Online]. Available at:
https://static1.squarespace.com/static/5cd497579b7d156e14cabd48/t/
5da5f1d7c0b761646010224f/1571156444155/NF+Arterial+
Enhanced-+SDS+US-CAN+4.9.3.4English+%28US%29.pdf (accessed
30 April 2020).
8. Balta JY, Twomey M, Moloney F, Duggan O, Murphy KP,
O'Connor OJ, Cronin M, Cryan JF, Maher MM, O'Mahony SM
(2019) A comparison of embalming fluids on the structures and
properties of tissue in human cadavers. Anat Histol Embryol 48:
64–73
9. Rajasekhar SSSN, Kumar VD, Raveendranath V, Kalayarasan R,
Gnanasekaran S, Pottakkat B, Sivakumar M (2021) Advanced
training in laparoscopic gastrointestinal surgical procedures using
Genelyn®-embalmed human cadavers: a novel model. J Minim
Access Surg 0:0. https://doi.org/10.4103/jmas.JMAS_152_20
10. Rajasekhar SSSN, Kumar VD, Gnanasekaran S, Pottakkat B,
Kalayarasan R, Raveendranath V, Gurram RP. Learning gains of
liver resection and transplantation workshop on Genelyn®
embalmed human cadavers: surgical gastroenterologists’ percep-
tions. doi: https://doi.org/10.1016/j.jceh.2021.01.001
Publisher’s Note Springer Nature remains neutral with regard to jurisdic-
tional claims in published maps and institutional affiliations.