The Use of Surgical Simulators to Reduce Errors

Abstract

The training of a surgeon includes the acquisition of a number of characteristics. These include a cognitive knowledge base, problem formulation and decisionmaking abilities, appropriate psychosocial relationships, and other attributes that can be measured with objective testing, such as national board or specialty certifying examinations. Perhaps most critical to the surgeon, however, are the core technical skills of the profession. A battery of sophisticated devices is being created to teach and provide objective evaluations of the trainee's technical abilities. These innovative state-of-the-art simulation devices, used to teach basic skills and surgical tasks through repetitive proctored challenges, will enable detection and analysis of surgical errors and near miss incidents without risk to patients. As with flight simulation, near miss detection capabilities anticipate potential errors before they occur and prevent resulting complications. In collaboration with a number of otolaryngology residency programs, we have developed a comprehensive training curriculum, based on complementary simulation tools and several perceptual and spatial ability test instruments, to provide objective metrics for assessing the technical skills of trainees. These tools include an endoscopic sinus surgery simulator for procedural training, and the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) system for basic surgical skills training. Technical errors are identified, quantified, and used to monitor surgical performance, after which the metrics are used for outcome analysis, for the purpose of improving patient safety. Validated metrics include time-to-completion, errors, economy of motion, and psychomotor tracking. Endoscopic sinus surgery is a suitable operation substrate, since it is a frequently performed procedure (more than 300,000 times annually in the United States.) and carries a significant risk of injury to the delicate neighboring eye and brain structures. The endoscopic sinus surgery simulator (ES3) is an advanced surgical simulation device based largely on jet pilot flight simulation, and provides the trainee with appropriate levels of challenge and instruction. ES3 validation studies are reported here, along with a description of the World Wide Web-based Intelligent Information Interface (WI3) simulation database.

Content and Construct Validation of a Robotic Surgery Curriculum Using an Electromagnetic Instrument Tracker

“…Calculated economy of motion, which is a surrogate for precision, was derived from time divided by path length. 4 An observer assigned penalty was assessed for dropping blocks or rings and for failing to precisely place suture and adequately tie the intracorporeal knot. Mean performance metrics were compared between the 2 groups with the independent t test using STATA®.…”

Balancing standardized testing with personalized training in surgery

“…In addition, such simulators can measure even tiny errors and near misses, which are not easy to identify in real-life settings 26. Because a simulator can accurately calculate the path of the virtual instrument and how close to an anatomical hazard an instrument is placed, it can measure near misses that may or may not result in a postoperative complication, thus training residents to avoid them in real life.…”

A hierarchical task analysis of shoulder arthroscopy for a virtual arthroscopic tear diagnosis and evaluation platform (VATDEP)

“…In contrast, VR based surgical simulators could offer a low‐cost, realistic risk‐free training and assessment platform . Existing studies noted that continuous training and receiving objective feedback in VR simulators can enhance surgical performance . Quantitative performance assessment with VR simulation needs to be translated to actual OR experience.…”