Surgical Simulation Training Research Articles

Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity.

Congenital heart surgery (CHS) is technically demanding, and its training is extremely complex and challenging. Training of the surgeon’s technical skills has relied on a preceptorship format in which the trainees are gradually exposed to patients in the operating room under the close tutelage of senior staff surgeons. Training in the operating room is an inefficient process and the concept of a learning curve is no longer acceptable in terms of patient outcomes. The benefits of surgical simulation in training of congenital heart surgeons are well known and appreciated. However, adequate surgical simulation models and equipment for training have been scarce until the recent development of three-dimensionally (3D) printed models. Using comprehensive 3D printing and silicone-molding techniques, realistic simulation training models for most congenital heart surgical procedures have been produced. Newly developed silicone-molded models allow efficient CHS training in a stress-free environment with instantaneous feedback from the proctors and avoids risk to patients. The time has arrived when all congenital heart surgeons should consider surgical simulation training before progressing to real-life operating in a similar fashion to the aviation industry where all pilots are required to complete simulation training before flying a real aircraft. It is argued here that simulation training is not an option anymore but should be a mandatory component of CHS training.

Validating the accuracy of a novel virtual reality platform for determining implant orientation in simulated primary total hip replacement.

Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model. The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson's r) and linear regression (R2). A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, -0.01°, 0.01° and -0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson's r = 0.92, 0.94, 0.99 and 0.99, and adjusted R2 = 0.82, 0.9, 0.98 and 0.98, respectively. The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery.

Building and training a low-cost and portable vascular anastomosis simulator: Initial experience of a surgical resident

Introduction and objectivesSeveral factors have caused the operating room to no longer be the ideal place for early surgical training, forcing the search for more effective options for simulation-based surgical learning. The objective of our study was to design and build a home-made proposal for a vascular anastomosis simulator for surgical training. MethodsDescriptive, preliminary, observational, analytical, and prospective study. The study was divided into two phases, the simulator construction with low-cost common materials (9.75$), and its operative evaluation with the Objective Structured Assessment of Technical Skills (OSATS-Modified). The study subject was a cardiothoracic surgery junior resident (postgraduate year two, PGY-2) who used the simulator and was evaluated through recorded sessions in 2 consecutive 3-month periods (first period, FP vs. second period, SP) by a senior surgeon. The acquisition of operative skills in the creation of end-to-side (E-T-S), side-to-side (S-T-S), end-to-end (E-T-E) vascular anastomoses were evaluated. ResultsThere were 273 sessions with a total of 4904min of simulation training between the three anastomosis modalities. A significant improvement was identified in the final OSATS-Modified scores (FP vs. SP) in the use of the Castroviejo needle holder, needle angles, and needle transfer in the E-T-S anastomosis (p<.05); graft orientation, appropriate spacing, use of Castroviejo needle holder, and the needle angles in the S-T-S (p<.05), and in the use of the Castroviejo needle holder, and needle transfer in the E-T-E (p<.05). Significant improvement was reported in E-T-S anastomosis time and S-T-S (p<.05). ConclusionsOur home-made portable prototype has proven to be very efficient in improving operational skills on a smaller scale; however, our findings need to be extrapolated to a larger population of surgical residents. Current evidence suggests that skills acquired through simulation-based training are transferred and positively impact the surgical environment.

The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: Visual spatial ability as a predictor for improved surgical performance: a randomized trial.

Introduction:Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training.Methods:In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities.Results:Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training.Conclusions:Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.

A systematic review of facial plastic surgery simulation training models.

The coronavirus disease 2019 pandemic has led to a need for alternative teaching methods in facial plastics. This systematic review aimed to identify facial plastics simulation models, and assess their validity and efficacy as training tools. Literature searches were performed. The Beckman scale was used for validity. The McGaghie Modified Translational Outcomes of Simulation-Based Mastery Learning score was used to evaluate effectiveness. Overall, 29 studies were selected. These simulated local skin flaps (n = 9), microtia frameworks (n = 5), pinnaplasty (n = 1), facial nerve anastomosis (n = 1), oculoplastic procedures (n = 5), and endoscopic septoplasty and septorhinoplasty simulators (n = 10). Of these models, 14 were deemed to be high-fidelity, 13 low-fidelity and 2 mixed-fidelity. None of the studies published common outcome measures. Simulators in facial plastic surgical training are important. These models may have some training benefits, but most could benefit from further assessment of validity.

Changed Landscapes of Surgical Education During COVID-19 Pandemic: Implications on Future Surgeons' Competence.

There has been a substantial impact on surgical education globally due to COVID-19 pandemic. The subtle and overt changes in surgical training programs during this pandemic along with its possible implications on the competence of future surgeons needs to be analyzed. If the essential measures are not taken in time, the surgical training programs are in a probable risk of failing to help surgery trainees successfully transition to the next phase of their surgical career. With a timely intervention for remediation, the surgery education programs will be sending surgical graduates into the community and society with the level of competency, expected from a surgeon despite COVID-19 pandemic. Keywords: COVID-19; surgical education; surgical simulation training.

Expanding the Spectrum of Surgical Simulation Training

Journal of the American College of Surgeons: December 2021 - Volume 233 - Issue 6 - p 708-709 doi: 10.1016/j.jamcollsurg.2021.08.680

Evaluating the ability of students to learn and utilize a novel telepresence platform, Proximie.

Novice users of telesurgery could be limited by their experience and technical ability. The impact of the COVID-19 pandemic on health care systems is unprecedented, and telehealth allowed care providers and patients a safety margin. An indirect impact of redeployment of hospital staff during COVID-19 management has been on the reduced educational opportunities for residents. Proximie can be considered as a virtual teaching platform or classroom for any user. Twenty-one students voluntarily participated in utilizing a da Vinci® skills simulator (dVSS) to carry out surgical training simulation tasks. Our study focuses on digital native’s adaptation to utilizing Proximie’s augmented reality platform to direct task performance, to gauge its feasibility by this unique cohort.

PJY03 - Evaluating the ability of students to learn and utilize a novel telepresence platform, proximie

Novice users of telesurgery could be limited by their experience and technical ability. The impact of the COVID-19 pandemic on health care systems is unprecedented, and telehealth allowed care providers and patients a safety margin. An indirect impact of redeployment of hospital staff during COVID-19 management has been on the reduced educational opportunities for residents. Proximie can be considered as a virtual teaching platform or classroom for any user. Twenty-one students voluntarily participated in utilizing a da Vinci® skills simulator (dVSS) to carry out surgical training simulation tasks. Our study focuses on digital native's adaptation to utilizing Proximie's augmented reality platform to direct task performance, to gauge its feasibility by this unique cohort.

The Use of Porcine Exenteration Specimens for Simulated Surgical Training in Ophthalmology.

The Use of Porcine Exenteration Specimens for Simulated Surgical Training in Ophthalmology.

Effect of video games playing on surgical simulation training: a systematic review.

Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. This study aims to systematically review the existing evidence. A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.

1306 Recommendations for the Use of Simulators in Cardiothoracic Surgical Training

Abstract Aim To systematically review the simulators that are currently available for cardiothoracic surgical procedures and the validation evidence supporting them. Additionally, to recommend several simulators for training based on analysis of results. Method A systematic literature search of the MEDLINE® (1946 to December 2019) and EMBASE® (1947 to December 2019) databases was performed to identify simulators for basic skills and procedures in cardiothoracic surgery. A selection of keywords and MeSH terms were used to execute the literature search. After identification of relevant articles, data were extracted and analysed. Results Ninety simulators were found in eighty-one articles. Simulators for basic skills (n=24) and coronary artery bypass graft (n=22) were the most commonly described, followed by miscellaneous (n=14), valve surgery (n=13), thoracic lobectomy (n=10), and mechanical circulatory support (n=7). The majority of models were either benchtop (n=42) or hybrid (n=33) modalities. Evidence of validity was demonstrated in 38 (42.2%) simulators. Five (5.6%) simulators had three or more elements of validity established and only one (1.1%) accomplished full validation. Conclusions Five simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills development and high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilised in early training, at which point the learning curve of trainees is steepest.

Surgical Simulation and Digital Tools for Surgical Training During the COVID-19 Pandemic

Surgical Simulation and Digital Tools for Surgical Training During the COVID-19 Pandemic

Force display control system for simultaneous 3-axis translational motion in surgical training simulator for chiseling operation

The present study proposes an advanced force display control system for a surgical training simulator with virtual reality. In oral and orthopedic surgeries, a surgeon uses a chisel and mallet for chiseling and cutting hard tissue. To enable the representation of force sensation for the chiseling operation in a virtual training simulator, the force display device has been constructed with the ball-screw mechanism to obtain high stiffness. In addition, two-degrees-of-freedom (2DOF) admittance control has been used to react instantaneously to the impactive force caused by pounding with the mallet. The virtual chiseling operation was realized by the force display device with a single axis in the previous studies. In the current study, we propose the design procedure for the force display control system with the 2DOF admittance control approach to virtual operation in three-dimensional space. Furthermore, we propose the design method for the PD controller with imperfect derivative using frequency characteristics for the 2DOF admittance control system. The efficacy of the proposed control system is verified through the virtual experience from manipulating the chisel using the developed force display device in the current study.

Recommendations for the use of coronary and valve simulators in cardiac surgical training: a systematic review.

The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results. A systematic literature search of the MEDLINE® (1946 to May 2021) and EMBASE® (1947 to May 2021) databases was performed to identify simulators for coronary artery and valvular procedures in cardiothoracic surgery. A selection of keywords and MeSH terms was used to execute the literature search. After identification of relevant articles, data were extracted and analysed. Thirty-seven simulators were found in 31 articles. Simulators were found for coronary artery bypass graft (n = 24) and valve surgery (n = 13). The majority of models were either benchtop (n = 28) or hybrid (n = 8) modalities. Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two (59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had 3 or more elements of validity established. Two simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills' development whereas high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilized in early training, at which point the learning curve of trainees is steepest.

A virtual reality based surgical skills training simulator for catheter ablation with real-time and robust interaction

BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia that can cause severe heart problems. Catheter ablation is one of the most ideal procedures for the treatment of AF. Physicians qualified to perform this procedure need to be highly skilled in manipulating the relevant surgical devices. This study proposes an interactive surgical simulator with high fidelity to facilitate efficient training and low-cost medical education. MethodsWe used a shared centerline model to simulate the interaction between multiple surgical devices. An improved adaptive deviation-feedback approach is proposed to accelerate the convergence of each iteration. The periodical beating of the human heart was also simulated in real time using the position-based dynamics (PBD) framework to achieve higher fidelity. We then present a novel method for handling the interaction between the devices and the beating heart mesh model. Experiments were conducted in a homemade simulator prototype to evaluate the robustness, performance, and flexibility of the proposed method. Preliminary evaluation of the simulator was performed by medical students, residents, and surgeons. ResultsThe interaction between surgical devices, static vascular meshes, and beating heart mesh was stably simulated in a frame rate suitable for interaction. ConclusionOur simulator is capable of simulating the procedure of catheter ablation with high fidelity and provides immersive visual experiences and haptic feedback.

Augmented reality-based visual-haptic modeling for thoracoscopic surgery training systems

BackgroundCompared with traditional thoracotomy, video-assisted thoracoscopic surgery (VATS) has less minor trauma, faster recovery, higher patient compliance, but higher requirements for surgeons. Virtual surgery training simulation systems are important and have been widely used in Europe and America. Augmented reality (AR) in surgical training simulation systems significantly improve the training effect of virtual surgical training, although AR technology is still in its initial stage. Mixed reality has gained increased attention in technology-driven modern medicine but has yet to be used in everyday practice. MethodsThis study proposed an immersive AR lobectomy within a thoracoscope surgery training system, using visual and haptic modeling to study the potential benefits of this critical technology. The content included immersive AR visual rendering, based on the cluster-based extended position-based dynamics algorithm of soft tissue physical modeling. Furthermore, we designed an AR haptic rendering systems, whose model architecture consisted of multi-touch interaction points, including kinesthetic and pressure-sensitive points. Finally, based on the above theoretical research, we developed an AR interactive VATS surgical training platform. ResultsTwenty-four volunteers were recruited from the First People's Hospital of Yunnan Province to evaluate the VATS training system. Face, content, and construct validation methods were used to assess the tactile sense, visual sense, scene authenticity, and simulator performance. ConclusionsThe results of our construction validation demonstrate that the simulator is useful in improving novice and surgical skills that can be retained after a certain period of time. The video-assisted thoracoscopic system based on AR developed in this study is effective and can be used as a training device to assist in the development of thoracoscopic skills for novices.

Medical Data and Mathematically Modeled Implicit Surface Real-Rime Visualization in Web Browsers

Raycasting can display volumetric medical data in fine details and reveal crucial inner imaging information, while implicit surface is able to effectively model complex objects with high flexibility, combining these two rendering modalities together will provide comprehensive information of the scene and has wide applications in surgical simulation, image-guided intervention, and medical training. However, medical data rendering is based on texture depth at every sampling point, while mathematically modeled implicit surfaces do not have geometric information in texture space. It is a challenging task to visualize both physical scalar data and virtual implicit surfaces simultaneously. To address this issue, in this paper, we present a new dual-casting ray-based double modality data rendering algorithm and web-based software platform to visualize volumetric medical data and implicit surface in the same browser. The algorithm runs on graphics processing unit and casts two virtual rays from camera to each pixel on the display panel, where one ray travels through the mathematically defined scene for implicit surface rendering and the other one passes the 3D texture space for volumetric data visualization. The proposed algorithm can detect voxel depth information and algebraic surface models along each casting ray and dynamically enhance the visualized dual-modality data with the improved lighting model and transparency adjustment function. Moreover, auxiliary innovative techniques are also presented to enhance the shading and rendering features of interest. Our software platform can seamlessly visualize volumetric medical data and implicit surfaces in the same web browser over Internet.

Impact of Video Describing Cataract Surgical Simulator Training on Patients' Perceptions of Resident Involvement in Cataract Surgery

Abstract Purpose The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident. Design Cross-sectional survey. Methods An anonymous Likert-style survey was conducted among 430 consecutive adult patients who presented for eye examination at the Penn State Health Eye Center. The survey included questions regarding demographics, understanding of the medical training hierarchy, and patient willingness to have a resident perform their cataract surgery. There were six questions regarding patient willingness to have residents perform their cataract surgery and the second question in this set informs the patient that residents are supervised by an experienced cataract surgeon. Patients were randomly assigned to one of two groups: patients in Group 1 completed the survey only, while patients in Group 2 watched a 1-minute video describing resident training with a cataract surgical simulator prior to completing the survey. Results Four hundred fourteen of the 430 patients (96.3%) completed the survey. Overall, 24.7% (n = 102) of respondents expressed willingness to allow an ophthalmology resident to perform their cataract surgery, and that proportion increased to 54.0% (n = 223) if the patient was informed that the resident would be supervised by an experienced cataract surgeon. Patients in Group 2 were twice as likely compared with patients in Group 1 to express willingness to allow an ophthalmology resident to perform their cataract surgery (odds ratio 1.92 [1.18–3.11], p = 0.009). Conclusions A thorough informed consent process including information regarding attending supervision and a brief video detailing resident training with a cataract surgery simulator may increase patient willingness to allow resident participation in cataract surgery.

Development of platform for education and learning in minimally invasive pancreatic surgery

In an era when minimally invasive pancreatic surgery is rapidly increasing, there is a desperate need for an educational program for the safe establishment and standardization of minimally invasive pancreaticoduodenectomy. This study aimed to develop a program that will enable easy access to educational materials and software development that can perform surgical simulation as an educational platform for minimally invasive pancreaticoduodenectomy. Two main training programsare development of surgical simulator and video-based training program. Surgical simulator is an in vitro mastery-based training kit which can practice two main reconstruction procedures of hepaticojejunostomy and pancreaticojejunostomy. Another is a video-based training program building webhard, which was categorized as 1. Korean minimally invasive pancreatic surgery (K-MIPS) education program, 2. Technical notes, and 3. K-MIPS online mentoring program. The K-MIPS education program consisted with expert's videos and public videos, allowing novice surgeons to learn the techniques of experienced surgeons. Technical notes provide lecture materials for members to upgrade their theoretical knowledge. K-MIPS online mentoring program is a highlight of this education program. This program contains three stages. Stage 1 is a video library, which provides important surgical pitfalls in procedure segmentation for stepwise approach. Here, novice surgeons can learn the each procedure in step-by-step following the experts' surgery. Stage 2 and 3 are online mentoring system. Novice surgeons can upload their in-vitro and in-vivo experience. Then, members of the board of education of K-MIPS plan to provide evaluation and hearfelt mentoring. With this online educational platform, we hope to establish feasible, practical, and effective surgical educational system for safe implementation of minimally invasive pancreatectomy in our society.