Simulation in surgery: a review

Abstract

The ability to acquire surgical skills requires consistent practice, and evidence suggests that many of these technical skills can be learnt away from the operating theatre. The aim of this review article is to discuss the importance of surgical simulation today and its various types, exploring the effectiveness of simulation in the clinical setting and its challenges for the future. Surgical simulation offers the opportunity for trainees to practise their surgical skills prior to entering the operating theatre, allowing detailed feedback and objective assessment of their performance. This enables better patient safety and standards of care. Surgical simulators can be divided into organic or inorganic simulators. Organic simulators, consisting of live animal and fresh human cadaver models, are considered to be of high-fidelity. Inorganic simulators comprise virtual reality simulators and synthetic bench models. Current evidence suggests that skills acquired through training with simulators, positively transfers to the clinical setting and improves operative outcome. The major challenge for the future revolves around understanding the value of this new technology and developing an educational curriculum that can incorporate surgical simulators.

Cryopreserved tracheal segments: a new tool for bench surgical training in thoracic surgery

“…The use of fresh human cadavers and live animal models, which are considered to be of high fidelity or reality are very limited due to availability, high costs, potential of transmitting infectious diseases as well as ethical issues [1][2][3] . Thus, lower fidelity or reality simulators comprise inorganic, virtual reality and synthetic bench models 8,10 , which sacrifice realism for lower cost, portability and potential for repetitive use 7,8,10 . It is well known that cryopreserved trachea maintain smooth muscle, cartilage and epithelium 12 , keeping its "live" anatomical shape and consistency, thus it can be used as a safe and reliable high fidelity simulator.…”

“…27 (8) (Figure 2 A). Each tracheal segment was cut between the trachea cartilages in two segments (Figure 2 A,B).…”

“…However, ethical/legal and economical issues in the use of human cadavers, live laboratory animals and virtual reality simulators have prompted the use of numerous bench models made of organic or synthetic materials [1][2][3][7][8][9][10][11] . Most of these bench models are focused to trainees in general surgery, but few bench models are available for cardiothoracic fellows.…”

Innovations in surgery simulation: a review of past, current and future techniques

“…Today, VR simulators combine actual surgical tools used in the operating room with extremely realistic computerized images. These "hybrid simulators" mimic entire operations with high fidelity (17).…”

“…Successful surgery on an anesthetized animal requires adequate control of hemostatic systems, thus replicating human surgery with high-fidelity (17). As a result, resident surgeons working on live animals can practice every element of an operation, including not only the technical skills involved in a procedure, but the avoidance of complications and their management when they arise.…”