Background and Aims: simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. surgical procedures can be simulated by increasingly complex and expensive techniques. this review gives an update on computer-based virtual reality (vr) simulators in training for laparoscopic cholecystectomies.Materials and Methods: from leading databases (medline, cochrane, embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. furthermore, seven studies comparing black boxes and simulators were included.Results: the results indicated any kind of simulator training (black box, vr) to be beneficial at novice level. after vr training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. no clinical follow-up data were found. optimal learning requires skills training to be conducted as part of a systematic training program. no data on the cost-benefit of simulators were found, the price of a vr simulator begins at eur 60 000.Conclusions: theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. the cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. in order to achieve optimal learning a validated training program is needed.

New attitudes to medical ethics and demands for efficiency have brought increased attention to surgical skills and training. It is important to characterize the expertise and skill involved in the multidimensional surgical profession. At a time of change, there is a need to discuss the nature of surgical expertise, and also the prospects for resident training, with special reference to new minimally invasive techniques (MIS). In this paper, we selectively review knowledge on surgical expertise and the specific demands placed on a skilled MIS surgeon. In addition, the review contains a selection of studies from those areas that have been seen as important for the future of training in surgery.

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The interpositioning of various materials to complete suturectomy for the treatment of craniosynostosis has been used by many surgeons to prevent early postoperative reunion. Clear scientific proof for this procedure has not yet been obtained with any material, however. A previously described model of experimental craniosynostosis was employed to examine the effects of an interpositioned biodegradable polyglycolic acid (PGA) membrane on the growing skull of 14 newborn rabbits. Additional 11 newborn rabbits served as controls, as on their skulls only unilateral resection of the coronal suture was performed (experimental craniosynostosis). The skulls were examined for shape and histology up to 6 months of age. The 11 rabbits in the control group developed a unilateral deformity on their calvaria as demonstrated by dry-skull osteometry. The 14 rabbit skulls having the interpositioning of a PGA membrane done into the resection site at the time of unilateral suturectomy were found to have grown in a remarkably symmetrical fashion. The interpositioning of a PGA membrane therefore seems to prevent the formation of a skull deformity during growth as compared with early suturectomy alone.

Within the framework of learning from errors this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The overall purpose is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated. The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together. The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision making. The findings showed that optimal context of learning about risks and potential errors of surgical operation is not always the authentic operation context. The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment-including powerful guidance-for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

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Craniosynostosis is described as a condition in which the premature closure of one or more cranial sutures is exposed as a skull deformity alone or accompanied by neurological disturbances. According to previous research it seemed possible to create an experimental model for investigating the disease by simply resecting a suture in a newborn rabbit. We resected 16 coronal sutures in 16 newborn rabbits and had the skulls investigated for shape and histology up to 6 months of age. A clear deformity at the cranial vault could be detected. The fused site of the suturectomy later on presented a suture-like structure which was macroscopically distinct from a normal skull suture. The procedure is thus established, first, for investigating procedures for treating craniosynostosis in the growing skull, and, secondly, for studying the pathophysiology of craniosynostosis.

The right coronal sutures of twelve (12) newborn rabbits were fixed with commercially available, self-reinforced poly-L-lactide miniplates, with eight (8) rabbits sham treated with titanium miniplate fixation as reference experiments, in order to demonstrate the possible effects on skull growth. After six (6) months follow-up, both types of plate were detected to have caused a similar asymmetry in the neurocranium. Therefore, in our opinion, fixing across growing sutures, even with the new biodegradable devices, should be avoided.