Simulators Benefit Surgeons and Patients

Simulators are extremely beneficial to young surgeons who want to learn to perform better cataract surgery, according to Alja Črnej MD.

“In an ideal world, every ophthalmological teaching facility would have a simulator, because the patients would benefit from it,” she said.

Approaching cataract surgery as a resident is not easy. Dr Črnej recalled how residents used to prepare for the capsulorhexis procedure by training using tomatoes or foil or spending a lot of their own money to access a wet lab abroad for just one week. Since ophthalmology is a highly surgical specialisation, providing residents access to good training before they start operating on human eyes is particularly important, she emphasised.

Dr Črnej’s experience with simulators started while she was in Boston, and it helped her a lot. “I spent three years doing research and not performing surgery, but I was lucky enough to have a simulator there, so when I returned to Slovenia, my home country, it was no hassle,” she said.

Adding simulators to teaching facilities is mainly beneficial because they are always accessible in the hospital, and the residents can repeat surgical steps until they fully master them, developing such skills gradually. Furthermore, simulators do not need disposables, so there is no need for pig eyes or instruments, and residents can practise their skills without time pressure, stress, or colleagues watching them.

“You can fail as many times as you want from the beginning and you can practise every step of the cataract surgery with the simulator at your own pace,” she said.

And how do simulators benefit the patients as well? Surgeons with simulator practice have been shown to experience reduced complications during surgery. Working with simulators that create the look and feel of real cataract surgery makes them more confident and self-assured of their skills.

Simulators allow trainees to track skills and performance improvement, helping them understand how far they went with their training. Such devices in training programmes could lead to standardisation, setting obligatory surgery step numbers before going to the next training level or entering the OR.

However, this is not an ideal world: simulators are expensive, and not all countries and facilities have them at their disposal, she said. ESCRS has been able to assist by offering a simulator area during its conferences and providing a Moving Simulator that travels all over Europe, which has already supported more than 300 students. The Society also sent the simulator to the Polish border to be at the disposal of Ukrainian surgeons.

“We asked participants for feedback,” Dr Črnej said. “And we got valuable feedback, especially from beginner surgeons. This was their first touch with cataract surgery, and most of them enjoyed it.”

Dr Črnej spoke at the Ophthalmology Foundation Symposium at the 2024 ESCRS Congress in Barcelona.

Alja Črnej MD, FEBO is an anterior surgeon specialist at the Pfeifer Eye Surgery Centre, Ljubljana, Slovenia.