The training of residents for acquisition of surgical skills and proficiency is a sequential process. The individual should be able to make appropriate decisions based on sound knowledge of anatomy, pathology and surgical technique. During training, one has to acquire the appropriate visual spatial abilities, efficiency, knowledge of the procedure, surgical abilities and principles of proper tissue handling. Traditionally, surgical training is done in cadaveric specimens, animals and patients under supervision. Ethical and legal issues progressively limit training in animals and patients. In Brazil the widespread use of cadavers for craniofacial training is almost impossible. Aiming to gain surgical skills and competencies there is a tendency to use surgical realistic simulators through synthetic models or virtual reality models linked to haptic devices providing tactile and kinesthetic sensations.
The purpose of this project was to present a new realistic surgical simulator for maxillofacial surgery. A realistic craniofacial model (human anatomic based) was developed in conjunction with the company ProDelphus. The model includes the craniofacial skeleton, as well as the soft tissue covering with its layered anatomical structures. Fractures of the mandible, maxila, zygomatic complex and orbit are simulated in the skeletal component. It allows imaging by computed tomography. The model went through the validation process by 15 experienced surgeons. Among those there were several who are also involved in resident training. Afterwards it was used in a trauma basic course designed for attendance by residents and graduate students. The scientific validation considered parameters such as identification of the fractures, consistency of the material, resistance of the material, identification of the mental nerve, infraorbital nerve and dissection plans, fracture fixation, soft tissue synthesis and radiological interface.
In the validation process, seven percent (7%) of the surgeons referred no problems with the model, 57% pointed out up to two minimal distortions when compared to the real anatomical structure which in their view do not impair the use of the model for training and 36% described up to four minimal distortions which should be modified to make the model apt for inexperienced surgeons training. The suggestions were duly noted to be implemented. When the model was used in the basic trauma course both instructors and young surgeons were very enthusiastic about it. A realistic simulator for surgical training should reflect the real anatomy, be atoxic, easy to handle, readily available and the cost should be as low as possible. The presented model meets several of those qualities and the materials used are totally recycable. Due to the current needs in surgical training the role of real and virtual simulators will be increasingly more important as teaching tools. The simulator presented can be effectively used as a component in the training of inexperienced surgeons and presents several advantages in the teaching of maxillofacial osteosynthesis over purely skeletal models.
Marcos Lyra is chief development officer for ProDelphus. Fernando Melhem Elias is a consultant for Implamed.
© 2014 Society for Simulation in Healthcare