When simulation in surgical training meets virtual reality
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When Simulation in Surgical Training Meets Virtual reality Editorial Constantine Karaliotas Received 30/08/2011 Accepted 14/10/2011
Abstract
Introduction
For hundreds of years, apprenticeship with experts and the method of “Learning by doing” represented the gold standard for surgical education and acquisition of surgical dexterity. At the best of times, animals, cadavers and patients constituted the «surface» on which surgeons would train, but whichever the model of simulation, it was not without its disadvantages. The evolution of laparoscopic and endoscopic surgery, mainly based on monitor-image, lacked 3-dimensional image information and haptic feedback; this shortcoming, along with the difficulties in eye-hand coordination, dictated the need to seek a new simulating model. The development of surgical virtual reality-simulators (VR - simulators) can offer a much-needed new dimension to the training of novice surgeons, students and residents by providing a safe and viable alternative. Models of a virtual patient can provide an evolved and realistic human anatomy that can simulate normal and pathological conditions in a virtual reality environment. In addition, VR-simulators can provide a structured learning environment w ith con trolled l evels of di fficulty. Training in a virtual reality environment could help surgeons to overcome the two most common difficulties in image-guided surgery: the lack of tactile and three-dimensional image information. Equally important is the training in a VR - environment, which could help surgeons avoid errors during real surgical performance. The level of transferrable learning to the operating room is acceptable.
Traditionally, novice surgeons were trained by didactic and apprenticeship experience. Animals, cadavers and patients constituted the «surface» on which surgeons would train . It would not be unreasonable for one to maintain that the performance of live-animal surgery requires highly skilled personnel. However, one should bear in mind certain important considerations: the anatomy of animals sometimes varies greatly from that of humans; use of an animal incurs increased cost; the surgical procedure in animals offers just a one-time experience and finally, the use of animals raises ethical issues. As concerns surgical training on a cadaver, this model does not offer the requisite functional response due to dead tissue; the surgeon acts with less caution and again, as with training on animals, it can only provide a one-time, costly experience of the surgical procedure in question. Finally, surgical training on patients carries the obvious risk to patient safety and is not always feasible. In Table 1, we tabulate the factors motivating the use of alternative methods of surgical training, according to R. Barnes [1]. Establishing alternatives of surgical training, coincides and confirms the need to develop more objective methods of assessing operative skill [2]. The dictum “To Err is Human”, is the best motivating criterion for building a safer health system, beginning
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