2016 ACAPS Winter Retreat
Simulation is defined as replication of a real-world process or system over time. Surgical Simulations have gained popularity in the recent years. There have been many studies evaluating the role of computer and real-life simulations in surgical training. In several surgical specialties, the use of standardized simulators has become a mandatory portion of the resident’s training, such as the fundamentals of laparoscopic surgery, which is a required part of the residency in general surgery.1 Simulators employ various types of models to represent real-world objects and systems.
Some of the most common types of models in simulations include the following:
- Physical models: these types of models are physical objects representing a process or system in a controlled and simplified fashion. The systems used for training in fundamentals of laparoscopic surgery represent physical models of the abdomen.
- Mathematical models: these models provide a description of an object or a system using mathematical algorithms and concepts commonly within a computer simulation.
- Graphical models: these types of models are based on graphical depiction of an object or a system. Graphical models can be 2-dimensional or 3-dimensional.
- Finite element models: in this method of modeling, large and complex objects or systems are divided into much smaller and simpler parts with more predictable and defined behavior. The simulators can sum up the behavior of the smaller parts to replicate the larger and more complex objects.
With advances in computer technology, the development of models has become easier and more affordable. A readily accessible source of data for creation of anatomical models is the Visible Human Project (https://www.nlm.nih.gov/research/visible/visible_human.html).
The members of the American Council of Academic Plastic Surgeons Committee on Simulation in collaboration with a commercial animation company developed a computer-based simulator to teach the latissimus dorsi breast reconstruction technique to the residents and medical students.2 There are numerous other examples of simulators, both physical and computer based, which have been developed in the recent years by interested faculty and residents. An example is a project from the Case Medical Center in Cleveland, Ohio, which was spearheaded by one of the residents. With the help of a small institutional grant, a mobile application was developed to help improve the informed consent process by enabling the patient to visually navigate through a procedure.3
Touch Surgery is a London- and NYC-based company that has developed many simulations of surgical procedures based on real surgical videos. These simulations are accessible on smart phones and tablets (https://www.touchsurgery.com).
With the advent of immersion technology, such as Oculus Rift (https://www.oculus.com/en-us/rift/) and Microsoft Hololens (https://www.microsoft.com/microsoft-hololens/en-us), the simulation world is experiencing a rapid shift toward virtual and augmented reality. Augmented reality represents a combination of computer-generated simulation and information superimposed on the real-world objects. The potential applications of these new technologies for medical and surgical training are immense.
Surgical simulations have improved significantly in the recent years. Required technology has become more readily available. More surgeon educators should become involved in the development of simulators for training of the next generation of plastic surgeons.
1. Zendejas B, Ruparel RK, Cook DA. Validity evidence for the fundamentals of laparoscopic surgery (FLS) program as an assessment tool: a systematic review. Surgical Endoscopy. 2016;30:512520.
2. Long S, Stern CS, Napier Z, et al. Educational Efficacy of a Procedural Simulator in Plastic Surgery: Phase I Multicenter Study. Plast
3. Long T, Roth M, Soltanian H. Augmenting the Concept of Informed Consent with Use of New Visual and Sharing Technology. 2015. Boston, MA.Presented at ASPS Annual Scientific Meeting.