Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review

Abstract

Background: Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model’s complexity, characteristics, advantages, disadvantages, and validation measures taken. Methods: A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. Results: Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. Conclusions: A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today’s training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

Realidad virtual y motivación en el contexto educativo: Estudio bibliométrico de los últimos veinte años de Scopus

“…El uso de la Realidad Virtual en el campo de la educación ha ganado un notable reconocimiento (Panerai, Catania, Rundo & Ferri, 2018) por ser una modalidad eficaz de formación y evaluación (Abi-Rafeh et al, 2019), la cual genera ventajas en los estudiantes (Klippel et al, 2019), entre las que se encuentra la comprensión de los contenidos planteados (Hanson, Andersen & Dunn, 2019), mejora de la creatividad (Yang et al, 2019) y rendimiento de los estudiantes (Cagiltay, Ozcelik, Berker & Menekse, 2019;Jacobsen et al, 2019), aumenta la participación (Lorenzo-Álvarez, Rudolphi-Soler, Ruiz-Gómez & Sendra-Portero, 2019) y el compromiso de los estudiantes hacia los contenidos y el aprendizaje (Makransky & Lilleholt, 2018), además de hacer más accesible la educación a todo el mundo (Sood & Singh, 2018) permitiendo con ello aumentar las competencias específicas de los discentes en su campo de conocimiento (Wu et al, 2019) Actualmente existen diversos estudios que analizan el uso de la Realidad Virtual y su influencia en la motivación, entre los que destacan los de Kim y Hall (2019), que determinaron que existe un efecto altamente significativo del disfrute percibido en aquellas personas que utilizan la Realidad Aumentada; Sattar et al (2019), que encontraron que la Realidad Virtual era lo mejor para los estudiantes de medicina, tanto en la motivación de aprendizaje como en la competencia de aprendizaje; Ho, Sun y Tsai (2019), que establecieron que los estudiantes del departamento de medios digitales mejora su motivación e interés por aprender animación 3D; Rockstroh, Blum y Goritz (2019), que determinaron que a la hora de implementar la Realidad Virtual a los procesos de enseñanza y aprendizaje, mejoraba la motivación y ayudaba a los usuarios a mantener la atención.…”

Superiority of living animal models in microsurgical training: beyond technical expertise

“…Following the advent of new-age VR technology, the next goal was to determine its predictive validity in human operating rooms. Virtual reality was seen as a new educational tool to both appeal to a growing movement toward minimizing live animal use, and as a new technological wave to update curricula [82]. While early results are encouraging, multidimensional VR applications have remained somewhat limited to specific subprocedures of broader operations, such as harvesting of free fibula and transplanting it for femoral head osteonecrosis.…”

“…Another examples of a simple DIY type of simulator are the plant-based model which uses the halved stem of a chive for microsurgical anastomosis [89], the grapefruit training model for cerebral artery side-to-side microsurgical bypass procedure [90], and other innovations related to neurosurgery [91,92]. Other considerable advantages of nonbiological microsurgical simulators include ease of setup and storage, low cost [93], low maintenance, repeated use, no risk of infectious disease transmission [82], and portability [94]. Thus, the transition from the ex vivo model to the in vivo one will be smooth for the resident [95][96][97].…”

Relevance of a simulation model to microsurgery for military surgical residents

“…On the other hand, initial training in the handling of instrument and anastomosis techniques can be carried out by means of simulation. Many models have been developed and evaluated in recent years with the aim of limiting the use of animal models due to ethical and nancial reasons [1][2][3].…”