Overview of Simulation in Surgery

  • Don J. SelzerEmail author
Part of the Comprehensive Healthcare Simulation book series (CHS)


Simulation-based training has demonstrated success in educating and assessing all level of learners from medical students to residents to practicing physicians. Along with this success has come the mandate to include a simulation center and/or skills lab at medical schools and many major healthcare organizations. Each institution uses these valuable resources differently. The keys to a successful program that maximizes education outcomes based upon the investment of time and money aren’t completely clear. However, a review of the benefits and drawbacks of each type of simulation will demonstrate that the building blocks for a robust curriculum and eventual assessment of technical and nontechnical skills are available.


Simulation Surgical education Technical skills Skills assessment 


  1. 1.
    Owen H. Early use of simulation in medical education. Simul Healthc. 2012;7(2):102–16.CrossRefGoogle Scholar
  2. 2.
    Medical education in the United States and Canada; a report to the Carnegie Foundation for the Advancement of Teaching. [S.l.]: New York; 1910.Google Scholar
  3. 3.
    Satava RM. Historical review of surgical simulation--a personal perspective. World J Surg. 2008;32(2):141–8.CrossRefGoogle Scholar
  4. 4.
    Britt LD, Richardson J. Residency review committee for surgery: an update. Arch Surg. 2007;142(6):573–5.CrossRefGoogle Scholar
  5. 5.
    Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, et al. Surgical simulation: a systematic review. Ann Surg. 2006;243(3):291–300.CrossRefGoogle Scholar
  6. 6.
    Dietl CA, Russell JC. Effects of technological advances in surgical education on quantitative outcomes from residency programs. J Surg Educ. 2016;73(5):819–30.CrossRefGoogle Scholar
  7. 7.
    Piromchai P, Avery A, Laopaiboon M, Kennedy G, O’Leary S. Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat. Cochrane Database Syst Rev. 2015;9:CD010198.Google Scholar
  8. 8.
    Dawe SR, Windsor JA, Broeders JA, Cregan PC, Hewett PJ, Maddern GJ. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg. 2014;259(2):236–48.CrossRefGoogle Scholar
  9. 9.
    Institute of Medicine (US) Committee on Data Standards for Patient Safety, Aspden P, Corrigan JM, Wolcott J, Erickson SM. Patient safety achieving a new standard for care. [S.l.]. Washington (DC): National Academies Press (US); 2004.Google Scholar
  10. 10.
    Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm : a new health system for the 21st century. Washington, D.C: National Academy Press; 2001. xx, 337 p. pGoogle Scholar
  11. 11.
    Stefanidis D, Sevdalis N, Paige J, Zevin B, Aggarwal R, Grantcharov T, et al. Simulation in surgery: what’s needed next? Ann Surg. 2015;261(5):846–53.CrossRefGoogle Scholar
  12. 12.
    Tavakol M, Mohagheghi MA, Dennick R. Assessing the skills of surgical residents using simulation. J Surg Educ. 2008;65(2):77–83.CrossRefGoogle Scholar
  13. 13.
    AdAdams AJ, Wasson EA, Admire JR, Pablo Gomez P, Babayeuski RA, Sako EY, et al. A comparison of teaching modalities and fidelity of simulation levels in teaching resuscitation scenarios. J Surg Educ. 2015;72(5):778–85.Google Scholar
  14. 14.
    Adams AJ, Wasson EA, Admire JR, Pablo Gomez P, Babayeuski RA, Sako EY, et al. A comparison of teaching modalities and fidelity of simulation levels in teaching resuscitation scenarios. J Surg Educ. 2015;72(5):778–85.Google Scholar
  15. 15.
    Anastakis DJ, Regehr G, Reznick RK, Cusimano M, Murnaghan J, Brown M, et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg. 1999;177(2):167–70.CrossRefGoogle Scholar
  16. 16.
    Sundar SJ, Healy AT, Kshettry VR, Mroz TE, Schlenk R, Benzel EC. A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents. J Neurosurg Spine. 2016;24(5):850–6.CrossRefGoogle Scholar
  17. 17.
    Camp CL, Krych AJ, Stuart MJ, Regnier TD, Mills KM, Turner NS. Improving resident performance in knee arthroscopy: a prospective value assessment of simulators and cadaveric skills laboratories. J Bone Joint Surg Am. 2016;98(3):220–5.CrossRefGoogle Scholar
  18. 18.
    Sheckter CC, Kane JT, Minneti M, Garner W, Sullivan M, Talving P, et al. Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ. 2013;70(4):466–74.CrossRefGoogle Scholar
  19. 19.
    Cabello R, Gonzalez C, Quicios C, Bueno G, Garcia JV, Arribas AB, et al. An experimental model for training in renal transplantation surgery with human cadavers preserved using W. Thiel’s embalming technique. J Surg Educ. 2015;72(2):192–7.CrossRefGoogle Scholar
  20. 20.
    Aboud E, Aboud G, Al-Mefty O, Aboud T, Rammos S, Abolfotoh M, et al. “Live cadavers” for training in the management of intraoperative aneurysmal rupture. J Neurosurg. 2015;123(5):1339–46.CrossRefGoogle Scholar
  21. 21.
    Carey JN, Rommer E, Sheckter C, Minneti M, Talving P, Wong AK, et al. Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg. 2014;67(2):e42–8.CrossRefGoogle Scholar
  22. 22.
    Ahmed K, Aydin A, Dasgupta P, Khan MS, McCabe JE. A novel cadaveric simulation program in urology. J Surg Educ. 2015;72(4):556–65.CrossRefGoogle Scholar
  23. 23.
    Zenati MA, Bonanomi G, Kostov D, Svanidze O. A new live animal training model for off-pump coronary bypass surgery. Heart Surg Forum. 2002;5(2):150–1.PubMedGoogle Scholar
  24. 24.
    Jacobs LM, Burns KJ, Kaban JM, Gross RI, Cortes V, Brautigam RT, et al. Development and evaluation of the advanced trauma operative management course. J Trauma Inj Infect Crit Care. 2003;55(3):471–9; discussion 479.CrossRefGoogle Scholar
  25. 25.
    Bailey RW, Imbembo AL, Zucker KA. Establishment of a laparoscopic cholecystectomy training program. Am Surg. 1991;57(4):231–6.PubMedGoogle Scholar
  26. 26.
    Gruber FP, Dewhurst DG. Alternatives to animal experimentation in biomedical education. ALTEX. 2004;21(Suppl 1):33–48.PubMedGoogle Scholar
  27. 27.
    Gala SG, Goodman JR, Murphy MP, Balsam MJ. Use of animals by NATO countries in military medical training exercises: an international survey. Mil Med. 2012;177(8):907–10.CrossRefGoogle Scholar
  28. 28.
    Sanfey H, Ketchum J, Bartlett J, Markwell S, Meier AH, Williams R, et al. Verification of proficiency in basic skills for postgraduate year 1 residents. Surgery. 2010;148(4):759–66; discussion 766–7.CrossRefGoogle Scholar
  29. 29.
    Van Bruwaene S, Schijven MP, Napolitano D, De Win G, Miserez M. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial. J Surg Educ. 2015;72(3):483–90.CrossRefGoogle Scholar
  30. 30.
    Al-Abed Y, Cooper DG. A novel home laparoscopic simulator. J Surg Educ. 2009;66(1):1–2.CrossRefGoogle Scholar
  31. 31.
    Desilets DJ, Banerjee S, Barth BA, Kaul V, Kethu SR, Pedrosa MC, et al. Endoscopic simulators. Gastrointest Endosc. 2011;73(5):861–7.CrossRefGoogle Scholar
  32. 32.
    Wais M, Ooi E, Leung RM, Vescan AD, Lee J, Witterick IJ. The effect of low-fidelity endoscopic sinus surgery simulators on surgical skill. Int Forum Allergy Rhinol. 2012;2(1):20–6.CrossRefGoogle Scholar
  33. 33.
    King N, Kunac A, Merchant AM. A review of endoscopic simulation: current evidence on simulators and curricula. J Surg Educ. 2016;73(1):12–23.CrossRefGoogle Scholar
  34. 34.
    Gomez PP, Willis RE, Schiffer BL, Gardner AK, Scott DJ. External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum. J Surg Educ. 2014;71(6):839–45.CrossRefGoogle Scholar
  35. 35.
    Atesok K, Mabrey JD, Jazrawi LM, Egol KA. Surgical simulation in orthopaedic skills training. J Am Acad Orthop Surg. 2012;20(7):410–22.PubMedGoogle Scholar
  36. 36.
    Willis RE, Gomez PP, Ivatury SJ, Mitra HS, Van Sickle KR. Virtual reality simulators: valuable surgical skills trainers or video games? J Surg Educ. 2014;71(3):426–33.CrossRefGoogle Scholar
  37. 37.
    Davies J, Khatib M, Bello F. Open surgical simulation--a review. J Surg Educ. 2013;70(5):618–27.CrossRefGoogle Scholar
  38. 38.
    Johnston MJ, Paige JT, Aggarwal R, Stefanidis D, Tsuda S, Khajuria A, et al. An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains. Am J Surg. 2016;211(1):214–25.CrossRefGoogle Scholar
  39. 39.
    Sloan DA, Donnelly MB, Johnson SB, Schwartz RW, Strodel WE. Use of an objective structured clinical examination (OSCE) to measure improvement in clinical competence during the surgical internship. Surgery. 1993;114(2):343–50; discussion 350–1.PubMedGoogle Scholar
  40. 40.
    Pucher PH, Aggarwal R, Singh P, Srisatkunam T, Twaij A, Darzi A. Ward simulation to improve surgical ward round performance: a randomized controlled trial of a simulation-based curriculum. Ann Surg. 2014;260(2):236–43.CrossRefGoogle Scholar
  41. 41.
    Pena G, Altree M, Field J, Sainsbury D, Babidge W, Hewett P, et al. Nontechnical skills training for the operating room: a prospective study using simulation and didactic workshop. Surgery. 2015;158(1):300–9.CrossRefGoogle Scholar
  42. 42.
    Briggs A, Raja AS, Joyce MF, Yule SJ, Jiang W, Lipsitz SR, et al. The role of nontechnical skills in simulated trauma resuscitation. J Surg Educ. 2015;72(4):732–9.CrossRefGoogle Scholar
  43. 43.
    Bearman M, O’Brien R, Anthony A, Civil I, Flanagan B, Jolly B, et al. Learning surgical communication, leadership and teamwork through simulation. J Surg Educ. 2012;69(2):201–7.CrossRefGoogle Scholar
  44. 44.
    Krampe RT, Ericsson KA. Maintaining excellence: deliberate practice and elite performance in young and older pianists. J Exp Psychol Gen. 1996;125(4):331–59.CrossRefGoogle Scholar
  45. 45.
    Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl):S70–81.CrossRefGoogle Scholar
  46. 46.
    Crochet P, Aggarwal R, Dubb SS, Ziprin P, Rajaretnam N, Grantcharov T, et al. Deliberate practice on a virtual reality laparoscopic simulator enhances the quality of surgical technical skills. Ann Surg. 2011;253(6):1216–22.CrossRefGoogle Scholar
  47. 47.
    Hashimoto DA, Sirimanna P, Gomez ED, Beyer-Berjot L, Ericsson KA, Williams NN, et al. Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance. Surg Endosc. 2015;29(11):3154–62.CrossRefGoogle Scholar
  48. 48.
    Roberts NK, Williams RG, Kim MJ, Dunnington GL. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. J Am Coll Surg. 2009;208(2):299–303.CrossRefGoogle Scholar
  49. 49.
    Gostlow H, Marlow N, Babidge W, Maddern G. Systematic review of voluntary participation in simulation-based laparoscopic skills training: motivators and barriers for surgical trainee attendance. J Surg Educ. 2017;74(2):306–18.Google Scholar
  50. 50.
    Nishisaki A, Donoghue AJ, Colborn S, Watson C, Meyer A, Brown CA 3rd, et al. Effect of just-in-time simulation training on tracheal intubation procedure safety in the pediatric intensive care unit. Anesthesiology. 2010;113(1):214–23.CrossRefGoogle Scholar
  51. 51.
    Auerbach M, Fein DM, Chang TP, Gerard J, Zaveri P, Grossman D, et al. The correlation of workplace simulation-based assessments with Interns’ infant lumbar puncture success: a prospective, multicenter. Obs Study Simul Healthc. 2016;11(2):126–33.CrossRefGoogle Scholar
  52. 52.
    Zendejas B, Ruparel RK, Cook DA. Validity evidence for the fundamentals of laparoscopic surgery (FLS) program as an assessment tool: a systematic review. Surg Endosc. 2016;30(2):512–20.CrossRefGoogle Scholar
  53. 53.
    Hazey JW, Marks JM, Mellinger JD, Trus TL, Chand B, Delaney CP, et al. Why fundamentals of endoscopic surgery (FES)? Surg Endosc. 2014;28(3):701–3.CrossRefGoogle Scholar
  54. 54.
    Wood TC, Raison N, Haldar S, Brunckhorst O, McIlhenny C, Dasgupta P, et al. Training tools for nontechnical skills for surgeons-a systematic review. J Surg Educ. 2017;74(4):548–78.Google Scholar
  55. 55.
    Sariali E, Catonne Y, Pascal-Moussellard H. Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop. 2017;41(4):699–705.Google Scholar
  56. 56.
    Xuyi W, Jianping P, Junfeng Z, Chao S, Yimin C, Xiaodong C. Application of three-dimensional computerised tomography reconstruction and image processing technology in individual operation design of developmental dysplasia of the hip patients. Int Orthop. 2016;40(2):255–65.CrossRefGoogle Scholar
  57. 57.
    Ren J, Zhou Z, Li P, Tang W, Guo J, Wang H, et al. Three-dimensional planning in maxillofacial fracture surgery: computer-aided design/computer-aided manufacture surgical splints by integrating cone beam computerized tomography images into multislice computerized tomography images. J Craniofac Surg. 2016;27(6):1415–9.CrossRefGoogle Scholar
  58. 58.
    Lin JC, Myers E. Three-dimensional printing for preoperative planning of renal artery aneurysm surgery. J Vasc Surg. 2016;64(3):810.CrossRefGoogle Scholar
  59. 59.
    Zhang G, Zhou XJ, Zhu CZ, Dong Q, Su L. Usefulness of three-dimensional(3D) simulation software in hepatectomy for pediatric hepatoblastoma. Surg Oncol. 2016;25(3):236–43.CrossRefGoogle Scholar
  60. 60.
    Zeng N, Fang CH, Fan YF, Yang J, Xiang N, Zhu W, et al. The construction of three-dimensional visualization platform and its application in diagnosis and treatment for hilar cholangiocarcinoma. Zhonghua Wai Ke Za Zhi. 2016;54(9):680–5.PubMedGoogle Scholar
  61. 61.
    Lichtenstein JT, Zeller AN, Lemound J, Lichtenstein TE, Rana M, Gellrich NC, et al. 3D-printed simulation device for orbital surgery. J Surg Educ. 2017;74(1):2–8.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryIndiana University Health University Hospital, Indiana University School of MedicineIndianapolisUSA

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