Hand Surgical Simulation in the Pandemic Era: A Systematic Review

Introduction: The COVID-19 pandemic and duty hour restrictions have illuminated a role for surgical simulation in trainees that permits meaningful technical experience outside the operating room. There is a need for the implementation of surgical simulation infrastructure adjacent to clinical training with practical considerations for complexity and cost. This systematic review analyzes surgical simulations that train hand surgical techniques and procedures with subjective or objective competency assessment. Method(s): A systematic review was conducted according to PRISMA- P guidelines using the PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane databases. Selected search terms included procedures relevant to the field of hand surgery and various types of simulation training. Data, including skills and techniques taught and assessed, model type, equipment, cost, and emphasis placed in training for each article, were extracted. Result(s): Of 2,519 articles, 40 met inclusion criteria. Models were described as: synthetic benchtop/3D-printed (40.0%), animal (22.5%), cadaveric (20.0%), augmented and virtual reality (AR/ VR;12.5%), and other computer simulation (12.5%). Three models incorporated both a physical benchtop component and an AR/ VR component. The procedures most represented included tendon repair (30.0%), fracture fixation (27.5%), wrist arthroscopy (15.0%), and carpal tunnel release (15.0%). Sixty-five percent of articles emphasized the importance of surgical simulation in a surgeon's training. Conclusion(s): A diversity of surgical simulation models exist for the practice of various aspects of hand surgery. The existing literature demonstrates their utility for increasing expertise with surgical techniques and procedures in a low-risk setting.

A Systematic Review of Surgical Simulation in Gender Affirmation Surgery

INTRODUCTION: The burgeoning field of gender affirmation surgery (GAS) is increasingly complex, challenging Plastic Surgeons to meet elevated functional and cosmetic standards. During the COVID-19 pandemic, remote learning provided for simulation training, offering residents procedural exposure before treating patients. As GAS continues to evolve and the pandemic quells, there will be an increasing demand for GAS with the expectation for surgeons to be masters of these techniques. This systematic review summarizes current simulation training models in GAS. METHOD(S): A systematic review was conducted using PRISMA-P guidelines through the following databases: PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were English language peer-reviewed articles about surgical simulation techniques or training related to GAS. Skills and techniques taught and assessed, model type, equipment, and cost for each article were ed from articles. RESULT(S): Of 1,650 articles, 10 met inclusion criteria. Simulations included cadavers (n = 2), synthetic benchtop/3-dimensionally printed models (n = 6), and augmented/virtual reality interfaces (n = 2). Most simulations involved chest reconstruction +/- augmentation (n = 6) followed by vaginal reconstruction +/- repair (n = 3). One simulation involved facial GAS. All models emphasized surgical technique and anatomy. CONCLUSION(S): The evolving field of GAS requires that trainees be knowledgeable on surgical techniques surrounding this scope of practice. Surgical simulations teach residents to master operative techniques while addressing the sensitive nature of GAS. Given the new emphasis on remote learning, surgical simulation infrastructure adjacent to clinical training may benefit trainees with practical considerations for complexity and cost.