OBJECTIVE Opportunities are declining for residents to participate in complex open vascular surgical operations. Open simulation using fresh cadavers potentially can be used to familiarize residents with complex vascular exposures. We evaluated the use of fresh cadavers to assist resident comprehension of complex anatomic relationships in vascular surgery. METHODS Twenty-two postgraduate year (PGY) 3 (n = 12) and PGY 4 (n = 10) general surgery residents attended five structured 4-hour cadaver skills laboratories. Residents performed five conceptually difficult and infrequently encountered operative vascular exposures: the supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, proximal and distal renal arteries, and common iliac artery bifurcations. Residents were tested (oral board examination style with percentage correct of a predetermined checklist) in their knowledge and understanding of the anatomic relationships before and after the cadaver laboratories. Participants' self-reported confidence in performing these complex vascular exposures was also measured before and after the course using the operative confidence score (1 = not confident; 5 = highly confident) for each exposure. RESULTS Participation in the course resulted in increases in participant comprehension and self-reported operative confidence in the supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, renal arteries, and iliac bifurcation exposures. Before vs after the course, the mean oral examination scores were 5% vs 87%, 26% vs 94%, 19% vs 86%, 30% vs 88%, and 29% vs 87%, respectively (all P < .001), and mean operative confidence scores were 1.1 vs 2.9, 1.3 vs 3.5, 1.2 vs 3.2, 1.2 vs 3, and 1.5 vs 3.9, respectively (all P < 0.001). CONCLUSIONS Fresh cadaver laboratories can provide a learner-centered and safe environment for acquiring procedural understanding and operative confidence of complex vascular exposures. This may allow for the transformational change essential to becoming a competent vascular surgeon.