{"id":5048,"date":"2021-01-09T10:36:43","date_gmt":"2021-01-09T09:36:43","guid":{"rendered":"http:\/\/www.tauli.cat\/institut\/?p=5048"},"modified":"2021-08-03T12:46:05","modified_gmt":"2021-08-03T10:46:05","slug":"global-rd-trends-in-surgical-intervencionsim-simulation","status":"publish","type":"post","link":"https:\/\/www.tauli.cat\/institut\/actualitat\/vigilancia-tecnologica\/2021\/01\/global-rd-trends-in-surgical-intervencionsim-simulation\/","title":{"rendered":"Global R+D trends in Surgical & Intervencionsim Simulation","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"
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Most aspects of medicine have historically been learned in an apprenticeship model by means of observation, imitation, and instruction. This paradigm is rapidly changing towards the adoption of medical simulation. This is due to the irruption of more technology in surgeries and due to law maturation in the field. The following report captures the most interesting data of the field.<\/span><\/h3>\n

Commonly regarded essential competencies include manual dexterity, familiarity with high-tech equipment, sound professional judgment, and the ability to integrate technical skills with clinical practices. However, the incongruity between evidence-based recommendations and real-world practice highlights the inadequacy of the preceptored medical education tradition. Consequently, there has been a shift in the method of medical education towards experiential (\u2018hands-on\u2019) medical learning<\/strong> (1).<\/span><\/p>\n

Surgical simulation enhances surgical skills by allowing repeated practice and to maintain an acquired level of competence. Current high fidelity simulators offer the opportunity for safe, repeated practice and objective measurement of performance. Furthermore, it is a more efficient and cost-effective modality that poses no risk to patients and avoids many ethical and legal complications.\u00a0<\/span><\/p>\n

Although some form of simulation has existed for decades in surgical training, we are truly in the infancy stages of incorporating simulation into residency education. Beginning in July 2008, the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Surgery mandated that all surgery residency programs incorporate simulation within the curriculum of their program. <\/span>Even surgical simulation adoption is highly increasing in hospitals, many discussions remain open about if competencies acquired in the sim lab translates to clinical competence (2).<\/span><\/p>\n

Also, Virtual Reality (VR), or Virtual Environments (VE), -based simulators are rapidly becoming an integral part of surgical training and skills assessment.<\/span>[\/vc_column_text][vc_tta_accordion active_section=”0″][vc_tta_section title=”Most active medical areas for simulation” tab_id=”1608970665896-0f68ab10-604b”][vc_column_text]Over the last twenty-five years, there has been a strong movement towards changing the traditional approaches to surgical training. One of the major drivers for the development of surgical simulation is the advent of new surgical practices such as interventional radiology and MIS techniques. Example: bronchoscopy and laparoscopy. <\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n
Surgical Simulation<\/strong><\/span><\/td>\nUltrasound Simulation<\/strong><\/span><\/td>\n<\/tr>\n
Laparoscopic Surgical Simulators<\/span><\/td>\nAnesthesia\u00a0<\/span><\/td>\n<\/tr>\n
Arthroscopic Surgical Simulators<\/span><\/td>\nCardiology<\/span><\/td>\n<\/tr>\n
Cardiovascular Simulators<\/span><\/td>\nEmergency Medicine<\/span><\/td>\n<\/tr>\n
Obstetrics and Gynecology Simulators<\/span><\/td>\nIntensive Care Unit<\/span><\/td>\n<\/tr>\n
Orthopedic Simulators<\/span><\/td>\nOB\/GYN<\/span><\/td>\n<\/tr>\n
Spine Simulators\u00a0<\/span><\/td>\nRadiology<\/span><\/td>\n<\/tr>\n
Endovascular Simulators\u00a0<\/span><\/td>\nOthers (Urology, General Nursing, Pediatrics)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The complexity of instrument controls, restricted vision and mobility, difficult hand-eye coordination, unnatural perceptual-motor relationships, and the lack of tactile perception requires a high degree of manual dexterity and coordination<\/strong> from the operator. Consequently, much attention has been directed to new training methods such as surgical simulators for acquiring these skills (4).<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Overview of the different methods for surgical skills acquisition” tab_id=”1608970678251-cc880436-7c72″]

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Operating theater apprenticeship<\/h3> <\/div><\/div>[vc_column_text]Conventional surgical training is based on the apprenticeship model. Under the scrutiny of experienced instructors, surgical trainees learn by observing, then gradually performing specific procedures inside the operating theatre. <\/span>Although the operating theatre is a basic element of surgical training, it is becoming less effective<\/strong> due to several factors. First, trainees are exposed to the heterogeneous distribution of procedures<\/strong> depending on the flow of patients; it is also time-consuming<\/strong> and costly<\/strong>. <\/span>Moreover, operating theatre-based training can constitute a potential risk to patients<\/strong> due to the inevitable distraction while training on complex or advanced procedures. (1)<\/span>[\/vc_column_text]
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Animals and Cadavers<\/h3> <\/div><\/div>[vc_column_text]Students traditionally learn the basics of surgery on live lab animals. For example, the use of surgical instruments begins with anatomical dissections and physiological experiments. Anesthetised animals, typically pigs or rats, have long been a part of the curriculum in medical schools. However, this training modality is becoming increasingly unacceptable due to obvious ethical<\/strong>, legal<\/strong>, and human concerns<\/strong>. It is not only because of the tendency towards avoiding animal sacrifices for teaching purposes, but also because some infectious diseases can be transmitted from animals to trainees.<\/span> Moreover, from a technical point of view, the anatomy of animals and human beings are different, and the cost associated with preserving and disposing of used models is high (1).<\/span><\/p>\n

The most realistic, high-fidelity model remains human cadaver. Cadaver costs fall into <\/span>a modest price range, relative to other high-fidelity synthetic models (2).<\/span>[\/vc_column_text]

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Synthetic Models - task trainers<\/h3> <\/div><\/div>[vc_column_text]Synthetic models provide a low-risk training opportunity. Many models resembling parts of the human anatomy with complexity ranging from bone structures to fully integrated models are available. In practice, training with synthetic models is usually used during the preliminary stages of surgical education. This modality, however, has limited realism<\/strong> and it is also difficult and costly to acquire and maintain<\/strong> a large number of different cases (1).<\/span><\/p>\n

When considering the cost of simulation, task trainers may provide an economically viable alternative to high-fidelity and high-cost models. There are some examples in the literature showing the viability of simulation models for acquiring performing skills. As an example, Helder and collaborators demonstrated to improve aortic anastomosis in medical students and residents by using a low-cost ao<\/span>tic anastomosis model ($22.50\/unit), with pretest and posttest skills performed on a high-fidelity model (6).<\/span>[\/vc_column_text]

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Computer Based training<\/h3> <\/div><\/div>[vc_column_text]One of the established training methods is based on interactive multimedia applications where the trainee interacts visually with the system in order to learn the necessary steps involved in certain surgical procedures. <\/span>Nevertheless, it is still inadequate for providing effective training on basic surgical skills. This is largely due to the difficulty of imitating surgical procedures by using the Two-Dimensional (2D) CBT systems<\/strong> that have limited immersion, physical control, and interaction (1).<\/span><\/p>\n

Additive manufacturing<\/strong> and 3D scanning<\/strong> are contributing significantly to the advancement of computer-based training. Specifically, in surgical simulation are becoming a key technology for surgery planning and improving surgical outcomes. Also, Virtual Reality<\/strong> and Augmented Reality<\/strong> are emerging technologies in healthcare education and, although there are still limited randomized studies comparing its impact with the standard methods, some authors already suggest the importance of this technologies in improving quality of patients’ care.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Most relevant companies in the industry” tab_id=”1608972233768-8f176fb2-5074″][vc_single_image image=”5074″ img_size=”full”][vc_column_text]In this analysis, it has been determined the different types of medical simulation companies. Medical training market has demonstrated to be big enough to consolidate big, medium, and small corporations, also distributors, and very specialized companies. The market can be classified according to the following paramaters:<\/span><\/p>\n