Abstract
For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.
Similar content being viewed by others
References
Ackerman JM (1998) The visible human project. Proc IEEE 86: 504–511
American College of Surgeons (1995) Statement on laparoscopic and thoracoscopic procedures (ST-15), September, 1995, Chicago, Il
Chung JY, Sackier JM (1998) A method of objectively evaluating improvements in laparoscopic skills. Surg Endosc 12: 1111–1116 DOI: 10.1007/s004649900795
Cuschieri A, Wilson RG, Sunderland G, McIntyre IM, Youngson GG, Cash JD, Mackay N, Shields S (1997) Training initiative list scheme (TILS) for minimal access therapy: the MATTUS experience. J R Coll Surg Edinb 42: 295–302
Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM (1990) An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 37: 757–767
Delp SL, Zajac FR (1992) Force-and moment-generating capacity of lower limb muscles before and after tendon lengthening. Clin Orthop 284: 247–259
Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1998) Development of a model of evaluation and training of laparoscopic skills. Am J Surg 175: 482–487
Edmond CV, Wiet GJ, Bolger B (1998) Surgical simulation in otolaryngology. Otolaryngol Clin North Am 31: 369–381
Ellis SR (1991) Nature and origins of virtual environments: a bibliographical essay. Comput Systems Eng 2: 321–347
Faulkner H, Regehr G, Martin J, Reznick R (1996) Validation of an objective structured assessment of technical skills for surgical residents. Acad Med 71: 1363–1365
Gaba DM, DeAnda A (1988) A comprehensive anesthesia simulation environment: recreating the operating room for research and training. Anesthesiology 69: 387–394
Johnson R, Bhoyrul S, Way LW, Satava RM, McGovern K, Fletcher JD, Rangel S, Loftin RB (1996) Assessing a virtual reality surgical skills simulator. In: Weghorst SJ Sieburg HB Morgan K Healthcare in the information age: future tools for transforming medicine. IOS Press. Washington DC, pp 608–617
Krummel TM (1998) Surgical simulation and virtual reality: the coming revolution. Ann Surg 228: 635–637
Kuehnapfel UG, Neisius B (1993) CAD-based graphical computer simulation in endoscopic surgery. Endosc Surg Allied Technol 1: 181–184
Levy JS (1996) Virtual reality hysteroscopy. J Am Assoc Gynecol Laparosc 3: (suppl 4) S25-S26
Marescaux J, Clement JM, Tassetti V, Koehl C, Sotin S, Russier Y, Mutter D, Delingette H, Ayache N (1998) Virtual reality applied to hepatic surgery simulation: the next revolution. Ann Surg 228: 627–634
Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutichinson C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84: 273–278
Meller G (1997) A typology of simulators for medical education. J Digit Imaging 10: 194–196 (3 Suppl 1)
Merril JR, Merril GL, Raju R, Millman A, Meglan D, Preminger GM, Roy R, Babayan R (1995) Photorealistic Interactive 3-D graphics in surgical simulation. In: Satava RM Morgan K (eds) Interactive technology and the new medical paradigm for health care. IOS Press, Washington DC, pp 244–252
Merril JR, Merril GL, Raju R, Satava RM, Mortgan K, Mieburg MB, Mattheus R, Christiansen JP (1995) Photorealistic Interactive 3-D graphics in surgical simulation. In: Satava RM Morgan K (eds) Interactive technology and the new medical paradigm for health care. IOS Press, Washington DC, pp 244–252
Playter R, Raibert M (1997) A virtual surgery simulator using advanced haptic feedback. Minim Invasive Ther Allied Technol 6: 117–121
Raibert M, Playter R, Krummel TM (1998) The use of a virtual reality haptic device in surgical training. Acad Med 73: 596–5970
Reznick R, Regehr G, MacRae H, Martin J, McCulloch W (1997) Testing technical skill via an innovative bench station examination. Am J Surg 173: 226–230
Rosser JC, Rosser LC, Salvagi RS (1997) Skill acquisition and assessment for laparoscopic surgery. Arch Surg 132: 200–204
SAGES Guidelines and privileging and credentialing: standards for practice and continuing medical education of laparoscopic cholecystectomy. Am J Surg 161: 324–325
Satava RM (1996) Advanced simulation technologies for surgical education. Bull Am Col Surg 81: 77–81
Satava RM (1993) Virtual reality surgical simulator: the first steps. Surg Endosc 7: 203–205
Scott-Conner C (1998) The SAGES manual: fundamentals of laparoscopy and GI endoscopy. Springer Verlag, New York, pp
Sinclair MJ, Peifer JW, Haleblian R, Luxenberg MN, Green K, Hull DS (1995) Computer-simulated eye surgery: a novel teaching method for residents and practitioners. Ophthalmology 102: 517–521
Spitzer VM, Whitlock DG (1992) Electronic imaging of the human body: data storage and interchange format standards. In: Vannier MW Yates RE Whitestone JJ (eds) Proceedings of the Electronic Imaging of the Human Body Working Group. 9-11 March, pp 66–68
Author information
Authors and Affiliations
Additional information
The opinions or assertions contained in this article are the private views of the authors, and are not to be construed as official, or as reflecting the views of the Defense Advanced Research Projects Agency or the Department of Defense.
Rights and permissions
About this article
Cite this article
Satava, R.M. Accomplishments and challenges of surgical simulation. Surg Endosc 15, 232–241 (2001). https://doi.org/10.1007/s004640000369
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640000369