The Place of Surgery Simulation in the Healthcare System
With the advancement in technology, healthcare systems all around the world have incorporated the fanciest and most recent technologies to provide individualized training of doctors and better treatment plans to patients.
Along with these changes, the demand for surgical training outside of the operating room is also increasing day by day as the working hours of surgical trainees in the United States have been reduced, which demands the surgeon to acquire surgical skills and techniques in a shortened period of time.
Moreover, patient safety, limited exposure to surgical cases, and high costs of operation room-based training are demanding the development of new training methods.
These methods should be designed in an effective way to provide proper training to the surgeons along with the solution to the above-mentioned problems. This is the point where surgical simulation plays its role.
The aim of this review article is to discuss the importance of surgical simulation in the modern-day training of a surgeon, its various types, explore the effectiveness of simulation in the clinical setting, compare it with the traditional training methods, and its challenges for the future.
What is Surgery Simulation?
The surgical simulation comprises two words; Surgery and Simulation. A simulation is a technique designed in such a way as to replace or amplify real-life experiences with guided experiences that mimic the fundamental aspects of real life in an interactive manner. A surgical simulator is a device or model that helps to replicate real-time situations that healthcare professionals will encounter in real life while working in the hospital.
There is a wide range of surgical simulations, from single suture and knot practice for an entry-level trainee to advanced robotic surgery for complex surgeries involving a whole team of healthcare professionals.
History of Surgical Simulation
Surgical simulation may seem to be a modern technique, but it has a long history of almost 2500 years. The lead and clay model was used for nasal reconstruction simulation in India around 600 B.C., which is regarded as the earliest form of surgical simulation known to us. Wooden bench tops were also used as models for training them.
Dissection of cadavers for learning purposes is one of the most famous forms of surgical simulation, which is still in use. Live or anesthetized animals were also part of this technique.
With the advancements in technology, computerized patient simulators (manikins) were built in the 1980s, which became an integral part of training in no time. These were a good source of training without causing any harm to patients’ safety.
Late in the 1990s, the latest technology led to the emergence of virtual reality (VR) simulations which are computer-based systems. VR simulations are used by surgical trainees to practice surgical skills by manipulating computerized images and performing surgery in a virtual environment.
What are the Types of Surgical Simulation?
A large number of surgical simulators have been introduced in recent years that are unique and efficient. Each of them represents a particular surgical specialty or procedure. These can be generally divided into two types based on their ability to mimic reality (fidelity). These are:
These have a comparatively lower ability to mimic reality and are usually made to practice basic surgical skills such as suturing and knot-tying. These models are significant as they are cheap, available, and allow quick and repetitive simulation. These abilities allow the novice surgeon to practice basic skills and hand-eye coordination.
These models are comparatively advanced and have the capacity to replicate an entire surgery with a greater degree of realism. These are considered the most advanced and up-to-date techniques, such as endoscopic, laparoscopic, and robot-assisted surgeries (RAS).
Surgical simulators can also be categorized based on the material used in their development:
This group involves the use of live or anesthetized animals and cadavers for the learning purposes of novice surgeons.
This includes the use of plastic, rubber, and latex models to practice basic surgical skills such as suturing and knot-tying. These type of simulators and training has also been incorporated into courses by medical societies.
This is the most advanced type in which virtual reality is used to create a patient-specific three-dimensional model using the collected data through radiological images such as X-rays, CT-scan and MRI. This allows the construction of tissues, blood vessels, and bones, which can be assessed, and the surgeon can plan the trajectory of the approach to surgery. It also provides hand-eye coordination along with anatomical understanding of the patient.
These combine both the attributes of a physical simulator and a VR simulator, often as a mannequin linked to a computer program that can simulate physiological and physical responses, like bleeding as a reaction to the procedure.
Benefits of Surgical Simulation:
Surgical simulations have the ability to improve healthcare training and patient safety in many ways. Some of these are as follows:
- Simulators are important for the safe and standardized training of young doctors in surgery without any compromise on patient safety.
- These simulators provide a real-time experience to the trainees allowing them to refresh themselves and gain confidence in surgical skills. It is really important in mimicking rare and infrequent cases and risky procedures such as tracheostomy, airway intubation, and arterial cannulation.
- These are repetitive and provide work memory to the doctor in terms of practice.
- Most of the simulators are cheap and easily available to the trainees.
- Approach to the surgery and patient handling procedures can be standardized using simulation techniques.
- It also led to the development of minimally invasive procedures, such as endoscopy and laparoscopic procedures, which are beneficial for both patients and doctors.
Effectiveness of Surgical Simulation:
It has been shown by different studies that those trainees who have done training on surgical simulation models are able to perform better surgical procedures compared to those who have undergone traditional training only.
The surgical simulation also helped in standardizing the procedures and minimizing errors. Laparoscopic and endoscopic procedures have better outcomes in patients compared to open surgeries.
Minimally invasive surgery is also gaining popularity due to its effective results. But, more studies have to be done in order to show the effectiveness of surgical simulation in healthcare setups.
What are the Challenges to this Approach?
Along with the benefits of surgical simulations, there are also some challenges faced by healthcare authorities regarding this approach.
- Some of the simulators are expensive and not available in all healthcare centers, such as robot-assisted surgery (RAS).
- They need to be installed properly in the healthcare setup, and technical personnel is required to operate them.
- Moreover, managing surgical simulation techniques should be an active process with continuous progress and innovations because simply providing sophisticated machinery will not guarantee effective outcomes.
- They should be monitored, results should be studied, and appropriate changes should be made accordingly.
With the advances in technology and the use of minimally invasive procedures, more simulators with effective outcomes are necessary. Standardization of the procedure, regular monitoring of the outcomes, and evaluation of the effectiveness should be done in order to provide the best healthcare facilities to the patients and better training for the doctors. This is an ever-growing field, and every innovation should prove more beneficial and effective than the previous ones.
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Franco Cuevas is a physician who graduated from the National University of Córdoba, Argentina. He practices general medicine in the Emergency Department at Sanatorio de la Cañada, Córdoba. His focus is on writing medical content to improve physicians' access to relevant medical information for daily practice. He has participated in some research projects and has a special joy in teaching and writing about medical concepts.