Eye surgery simulator enables residents to hone phacoemulsification skills

Issue: November 25, 2011

Ophthalmology residents who practiced phacoemulsification techniques using a simulator performed faster surgery than those who did not receive such training, according to a study.

Results were published in the Journal of Cataract and Refractive Surgery.

“The use of surgery simulators in resident training offers the potential for better outcomes and decreased complication rates in resident phacoemulsification cases given its ability to develop the two-hand and two-foot coordination required during cataract extraction surgery in a setting that is safe for patients,” the study authors said. “Our results provide virtual reality-to-operating-room evidence of the potential benefit of the eye surgery simulator in resident education.”

The retrospective study included 42 third-year ophthalmology residents who performed 592 cataract procedures at one center. Seventeen residents had received training with the Eyesi surgery simulator (VRmagic) and 25 residents had not used the simulator. Of the 592 cases performed, 286 were done by residents with simulator training and 306 were handled by residents without simulator training.

Residents in the simulator group performed 16.8 cases on average; those in the non-simulator group performed a mean 12.2 procedures. One attending surgeon oversaw all procedures.

Primary outcome measures included phaco time, phaco power and intraoperative complications. Adjusted phaco time was calculated by multiplying phaco time by phaco power.

Residents in the simulator group had a mean phaco time of 1.88 minutes, mean adjusted phaco power of 25.32%, mean adjusted phaco time of 47.58 minutes, mean complication rate of 0.04 and mean complication grade of 2.33.

Residents in the non-simulator group had a mean phaco time of 2.41 minutes, mean adjusted phaco power of 28.19%, mean adjusted phaco time of 71.75 minutes, mean complication rate of 0.06 and mean complication grade of 2.47.

Data showed that between-group differences in phaco time, adjusted phaco time and phaco power were statistically significant (P < .002, P < .0001 and P < .0001, respectively).

Between-group differences in mean complication rate and mean complication grade were insignificant.

“Further investigation analyzing the effect of resident surgery simulator training on final corrected visual acuity is warranted at this time,” the authors said. – by Matt Hasson

Reference:

Belyea DA, Brown SE, Rajoub LZ. Influence of surgery simulator training on ophthalmology resident phacoemulsification performance. J Cataract Refract Surg. 2011;37(10):1756-1761.

Disclosure: The authors indicate no financial support for the development of this study and have no proprietary interest in any aspect of the study.

Multiple studies have shown that using a simulator such as the VRmagic simulator is helpful in teaching beginning surgeons how to develop the motor skills to perform eye surgery. Many of the rudimentary skills that people need to learn are basic, such as holding instruments or being able to find their hands under a microscope. To be able to use both hands and both feet at the same time — that is where the simulator is very helpful. It can teach these types of skills without having to practice on a live patient.

However, I do not believe a simulator is a panacea; it is only one of many necessary components in an educational program. A simulator can offer physical training with a small amount of feedback. What is lacking is the cognitive input that can only be given by live instruction from an experienced teacher. That being said, I believe simulation training is the way of the future in terms of teaching surgery. Simulation training will play a bigger and bigger role in education but will never completely be able to substitute for a live teacher.

– Bonnie An Henderson, MD
OSN Cataract Surgery Board Member
Disclosure: Dr. Henderson is a consultant for Alcon.