Surgical Endoscopy

, Volume 21, Issue 3, pp 357–366 | Cite as

Surgical simulation: a current review

  • B. Dunkin
  • G. L. Adrales
  • K. Apelgren
  • J. D. Mellinger
Review Article



Simulation tools offer the opportunity for the acquisition of surgical skill in the preclinical setting. Potential educational, safety, cost, and outcome benefits have brought increasing attention to this area in recent years. Utility in ongoing assessment and documentation of surgical skill, and in documenting proficiency and competency by standardized metrics, is another potential application of this technology. Significant work is yet to be done in validating simulation tools in the teaching of endoscopic, laparoscopic, and other surgical skills. Early data suggest face and construct validity, and the potential for clinical benefit, from simulation-based preclinical skills development. The purpose of this review is to highlight the status of simulation in surgical education, including available simulator options, and to briefly discuss the future impact of these modalities on surgical training.


Surgical Technical Digestive 


  1. 1.
    Aabakken L, Adamsen S, Kruse A (2000) Performance of a colonoscopy simulator: experience from a hands-on endoscopy course. Endoscopy 32:911–913PubMedCrossRefGoogle Scholar
  2. 2.
    Akerman M (1998) The visible human project. Proc IEEE 86:504–509CrossRefGoogle Scholar
  3. 3.
    Bar-Meir S (2000) A new endoscopic simulator. Endoscopy 32:898–900PubMedCrossRefGoogle Scholar
  4. 4.
    Bridges M, Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177:28–32PubMedCrossRefGoogle Scholar
  5. 5.
    Chaudry A, Sutton C, Wood J, Stone R, McCloy R (1999) Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human–computer interface. Ann R Coll Surg Engl 81:281–286Google Scholar
  6. 6.
    Datta V, Mandalia M, Mackay S, Darzi A (2002) The PreOp flexible sigmoidoscopy trainer: validation and early evaluation of a virtual reality based system. Surg Endosc 16:1459–1463PubMedCrossRefGoogle Scholar
  7. 7.
    Derossis AM, Antoniuk M, Fried GM (1999) Evaluation of laparoscopic skills: a 2-year follow-up during residency training. Can J Surg 42:293–296PubMedGoogle Scholar
  8. 8.
    Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1997) Development of a model for training and evaluation of laparoscopic skills. Am J Surg 175:482–487CrossRefGoogle Scholar
  9. 9.
    Dubrowski A, Backstein D, Abughaduma R, Leidl D, Carnahan H (2005) The influence of practice schedules in the learning of a complex bone-plating surgical task. Am J Surg 190:359–363PubMedCrossRefGoogle Scholar
  10. 10.
    Dunkin BJ (2003) Flexible endoscopy simulators. Semin Laparosc Surg 10:29–35PubMedGoogle Scholar
  11. 11.
    Dunkin BJ, Marks JM, Ponsky JL (2006) A multi-institutional international study evaluating the use of simulation technology to train fellows in colonoscopy. Presented at SAGES Annual Meeting, 2006, Dallas, TXGoogle Scholar
  12. 12.
    Feldman LS, Hagarty SE, Ghitulescu GA, Stanbridge D, Fried GM (2004) Relationship between objective and subjective assessment of technical skill in surgical residents. J Am Coll Surg 198:105–110PubMedCrossRefGoogle Scholar
  13. 13.
    Felsher JJ, Olesevich M, Farres H, Rosen M, Fanning A, Dunkin BJ, Marks JM (2005) Validation of a flexible endoscopy simulator. Am J Surg 189:497–500PubMedCrossRefGoogle Scholar
  14. 14.
    Ferlitsch A, Glauninger P, Gupper A, Schillinger M, Haefner M, Gangl A, Schoefl R (2002) Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy. Endoscopy 43:698–702CrossRefGoogle Scholar
  15. 15.
    Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17:964–967PubMedCrossRefGoogle Scholar
  16. 16.
    Gallagher AG, McClure N, McGuigan J, Crothers I, Browning I (1999) Virtual reality training in laparoscopic surgery: a preliminary assessment of minimally invasive surgical trainer virtual reality (MIST VR). Endoscopy 31:310–313PubMedCrossRefGoogle Scholar
  17. 17.
    Hyltander A, Liljegren E, Thodin PH, Lonroth H (2002) The transfer of basic skills learned in a laparoscopic simulator to the operating room. Surg Endosc 16:1324–1328PubMedCrossRefGoogle Scholar
  18. 18.
    Keyser EJ, Derossis AM, Antoniuk M, Sigman HH, Fried GM (2000) A simplified simulator for the training and evaluation of laparoscopic skills. Surg Endosc 14:149–153PubMedCrossRefGoogle Scholar
  19. 19.
    Korndorffer JR Jr, Dunne JB, Sierra R, Stefanidis D, Touchard CL, Scott DJ (2005) Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg 201:23–29PubMedCrossRefGoogle Scholar
  20. 20.
    Kwolek CJ, Donnelly MB, Sloan DA, Birrell SN, Strodel WE, Schwartz RW (1997) Ward evaluations: should they be abandoned? J Surg Res 69:1–6PubMedCrossRefGoogle Scholar
  21. 21.
    Larsson A (2001) An open and flexible framework for computer aided surgical training. Stud Health Technol Inform 81:263–265PubMedGoogle Scholar
  22. 22.
    Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD (2002) The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 167:1243–1247PubMedCrossRefGoogle Scholar
  23. 23.
    Munz Y, Kumar D, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers. Is one superior to the other? Surg Endosc 18:485–494PubMedCrossRefGoogle Scholar
  24. 24.
    Noble C (2002) The relationship between fidelity and learning in aviation training and assessment. J Air Transportation 7:33–54Google Scholar
  25. 25.
    Park A, Witzke D, Donnelly M (2002) Ongoing deficits in resident training for minimally invasive surgery. J Gastrointest Surg 6:501–509PubMedCrossRefGoogle Scholar
  26. 26.
    Peters JH, Fried GM, Swanstrom LL, Soper JN, Sillin LF, Schirmer B, Hoffman K (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135:21–27PubMedCrossRefGoogle Scholar
  27. 27.
    Rosser JC, Rosser LE, Savalgi RS (1997) Skill acquisition and assessment of laparoscopic surgery. Arch Surg 132:200–204PubMedGoogle Scholar
  28. 28.
    Satava RM (2001) Surgical education and surgical simulation. World J Surg 25:1484–1489PubMedCrossRefGoogle Scholar
  29. 29.
    Schijven M, Jakimowicz J (2002) Face-, expert, and referent validity of the Xitact LS500 Laparoscopy simulator. Surg Endosc 16:1764–1770PubMedCrossRefGoogle Scholar
  30. 30.
    Schijven M, Jakimowicz J (2003) Construct validity. Experts and novices performing on the Xitact LS500 laparoscopy simulator. Surg Endosc 17:803–810PubMedCrossRefGoogle Scholar
  31. 31.
    Schijven M, Jakimowicz J (2003) Virtual reality surgical laparoscopic simulators: how to choose. Surg Endosc 17:1943–1950PubMedCrossRefGoogle Scholar
  32. 32.
    Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191:272–283PubMedCrossRefGoogle Scholar
  33. 33.
    Seymour NE, Gallagher AG, Roman SA, O’Biren MK, Bansalo VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–464PubMedCrossRefGoogle Scholar
  34. 34.
    Warf BC, Donnelly MB, Schwartz RW, Sloan DA (1999) Interpreting the judgment of surgical faculty regarding resident competence. J Surg Res 86:29–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • B. Dunkin
    • 1
  • G. L. Adrales
    • 2
  • K. Apelgren
    • 3
  • J. D. Mellinger
    • 2
  1. 1.Department of SurgeryUniversity of Miami School of MedicineMiamiFlorida
  2. 2.Department of SurgeryMedical College of GeorgiaAugustaGeorgia
  3. 3.Department of SurgeryMichigan State University College of Human MedicineLansingMichigan

Personalised recommendations