Simulation in General Surgery

The ability to train competent surgeons to perform open general surgical procedures remains a top priority that has been complicated by a number of changes in medical and technical progress and decreased opportunities for clinical exposure. The result is trainees who, upon completion of training, are increasingly not fully prepared to independently perform the entirety of open procedures expected of general surgeons. Simulation has been proposed as part of the potential solution for this current and growing problem. While simulation technology has made great strides in the fields of minimally invasive surgery, simulators which allow for the training of open general surgical skills using actual instruments have lagged significantly behind. The ability of virtual reality to replicate open surgical procedures in which the instruments and the tissue characteristics can be replicated in a realistic fashion providing transfer of training to the patient has been elusive and likely not obtainable in the near term. Cadavers and animals can be utilized but have a number of limitations as will be discussed. The likely near-term solution will be the use of human tissue realistic physical models designed to augment the clinical experience of trainees in a standardized fashion. While there are a number of physical models currently available or under development that have the potential to meet this need, the current expense has prevented widespread use or expansion. This chapter will outline the current challenges in general surgical training that necessitates the need for further development and incorporation of simulation technologies. The current state of the art will be presented with examples of current and near-term future physical models that have significant potential for improving the training of general surgeons to perform open procedures.