Background: Surgical simulation is recognized as an instrument used in residency training, operative planning and in assessment of surgical skill. Despite available technology and abundant literature describing advantages of surgical simulation and virtual reality in surgery training, there remains a relative deficiency in development and use of similar technology in the plastic surgery curriculum.
Methods: Using the same technology used to create the cleft lip and palette simulation developed by Cutting1 and described previously, a model was developed to depict breast reconstruction following mastectomy2. For the purpose of describing our conceived techniques and methods, we focused on a latissimus musculocutaneous flap breast reconstruction post mastectomy, which warrants 3D visualization due to its complexity in shape, form, and spatial orientation. With recent emphasis on qualitative residency assessment and outcome based training, an assessment component with interactive questions was developed with hopes of providing objective data by documenting knowledge expressed as a percentage of correctly answered questions. Questions are interactive and incorporate anatomy and procedural knowledge, including indications and complications.
Results: AA vivid 3d animation was created and embedded into an interactive 3d environment for optimal viewing. Furthermore, we have started to break these virtual procedures into discrete peer-reviewed tasks and deploy the created content into surgical trainers capable of assessing cognitive knowledge.
Conclusion:Similar to aviation, which employed simulation to educate pilots in complex tasks, surgical simulation provides a milieu to teach surgeons procedures in a safe environment. We are currently designing a study to demonstrate the clinical utility of simulation in plastic surgery education. Benefits of simulation training have been reviewed in the literature in other disciplines, but we want to validate our model of breast reconstruction prior to developing additional simulations. Next steps will be to take what we have learned and illustrate the panoply of breast reconstruction options. Surgical simulators can provide residents the opportunity to practice a surgical procedure multiple times until it is perfected prior to performing that same procedure on a patient. Residents will still be able to experience hands on learning while still abiding by the rule of “first do no harm.” Nothing will ever replace the apprenticeship training that has propelled our field forward from its inception, but surgical simulation does provide obvious benefits to the training and advancement of our field. The construction of a 3D virtual reality library of simulations would be innovative and its impact on plastic surgery has the potential to be revolutionary.
1. Cutting, C., et al., Use of Three-Dimensional Comp. uter Graphic Animation to Illustrate Cleft Lip and Palate Surgery. Computer Aided Surgery, 2002. 7: p. 326-331
2. Qualter, J, et al., Visualizing Treatment Options for Breast Reconstructive Surgery. Medicine Meets Virtual Reality (MMVR17) Proceedings, January 2009,