A Systematic Review of Hand Surgery Simulation

The COVID-19 pandemic and duty hour restrictions illuminated a role for surgical simulation in hand surgery training that permits meaningful technical experience outside the operating room. Implementation of surgical simulation infrastructure alongside clinical training accounting for complexity and cost should be considered. This systematic review analyzes cadaveric, benchtop, 3D-printed, augmented/virtual reality, and animal models that may effectively simulate hand surgical techniques and procedures with subjective or objective competence assessment.

A systematic review was conducted according to PRISMA-P guidelines using the following databases: PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane. Selected search terms included procedures relevant to hand surgery and various simulation training modalities. Inclusion criteria were English-language peer-reviewed articles about surgical simulation techniques or hand surgery-related training. Abstracts, conference proceedings, non-English literature, and reviews were excluded. Data, including skills and techniques taught and assessed, model type, equipment, cost, and emphasis placed in training for each article, were entered into an electronic database. Additional articles were identified through references from the initial search.

Our search criteria identified 2745 articles, 39 of which met the inclusion criteria. Models were described with the following frequency: synthetic benchtop/3D printed (41.0%), animal (25.6%), cadaveric (17.9%), augmented and virtual reality (AR/VR; 10.3%), and other computer simulation (10.3%). Three models incorporated both a physical benchtop and AR/VR components. The procedures most represented by the simulation tools assessed include tendon repair (30.8%), fracture fixation (25.6%), wrist arthroscopy (15.4%), and carpal tunnel release (15.4%). Of all articles, 51.3% evaluated the efficacy of the educational tool. Of these, 40.0% were evaluated via subjective methods only, 10.0% via objective methods, and 50% via both. Eighty-seven percent of articles emphasized the importance of surgical simulation in a surgeon's training.

A diverse collection of hand surgical simulation models exists 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. Integration into surgical training will depend on program time and budget constraints.