R. Gulhar1, D. S. Brar1, G. Athwal1, R. Gulhar1 1California Northstate University College of Medicine,Elk Grove, CA, USA
Introduction:
Simulation training has played an important role in the training of surgical residents. Several factors including limited hours, financial pressure and increasing required knowledge have led to limited hands-on experience. Simulation allows for a controlled environment to train residents. While it is thought simulation benefits trainees it is not clear how simulation translates to actual procedures. There are a number of simulation techniques including manikin-based, standardized patient, virtual reality, and tissue-based simulation. In this review, we compare how different techniques of virtual simulation translate into real-world applications.
Methods:
We looked at studies from the last 17 years in order to analyze the use of various form of simulation including virtual reality, anatomical models, 3D printing, and virtual reality in orthopedic surgery. We evaluated them on the basis of reduction in surgery time, improvement in surgery quality, and overall increased performance.
Results:
The systematic review in 2016 showed that of the 31 studies conducted on the use of virtual reality, 16% showed improvement in the surgery quality and 26% showed an overall increase in successful skill acquisition for the knee and shoulder arthroscopy. Another study in 2018 compared performance of dynamic hip screw fixation of femur fractures in virtual reality simulation and operation theatre. There was no significant difference in performance outcome which was measured by tip apex distance.
A study conducted in 2018 looked at virtual simulation and 3D printing techniques for the surgical treatment of acetabular fractures with plate fixation. The study found that the 3D printing group had a shorter total surgical duration and less blood loss than those in the control group. The postoperative results were similar for both groups. However, the complication rate was lower in the 3D printing group.
In 2018 a study was done on the use of anatomical models in simulation. It looked at efficacy and validation of simulation-based compartment syndrome course. Results found that PGY1 residents demonstrated significant improvement and were comparable to PGY5 resident performance after one month of training.
Conclusion:
There is continued need to assess the use of different simulation techniques in orthopaedic surgery. Many studies show the use and effective incorporation of virtual simulation in orthopedics surgery. Although virtual simulation has become more widespread in orthopaedics it still lags behind other surgeries. Thus, development of new virtual reality training methods will allow for more accurate and cost-effective ways to train residents. Further research needs to be conducted in order to standardize the different forms of virtual reality across the spectrum of orthopedic surgery.