Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents

Abstract

Introduction: This retrospective consecutive case series examined whether training on a surgical simulator reduces intraoperative complication rates among novice ophthalmology residents learning cataract surgery.

Methods: Beginning July 2014, training on the Eyesi simulator became mandatory for novice postgraduate year 3 ophthalmology residents before live cataract surgery at our institution. Complication rates of the 11 simulator-trained residents (study group) were compared with their immediate 11 simulator-naive predecessors (comparison group). Only straightforward cataract cases (according to standardized preoperative criteria) where postgraduate year 3 residents served as the primary surgeon were included. Complication data were obtained from Morbidity and Mortality records and compared using Fisher exact test. A survey was administered to the residents to gauge the perceived utility of simulation training.

Results: The simulator-trained group (n = 501 cataract cases) and the simulator-naive comparison group (n = 454 cases) were analyzed. The complication rate in the simulator group was 2.4% compared with 5.1% in the comparison group (P = 0.037, Fisher exact test). Both the mean posterior capsule tear rate and vitreous prolapse rate in the simulator group were 2.2% compared with 4.8% in the comparison group (P = 0.032, Fisher exact test). The survey had a response rate of 100% (11/11), and 91% (10/11) of respondents felt that the training was "extremely worthwhile" and should be mandatory.

Conclusions: The addition of surgical simulation training was associated with a significantly reduced rate of complications, including posterior capsule tears and vitreous prolapse, among novice postgraduate year 3 residents. There is a perceived utility among residents to incorporate virtual simulation into surgical training.

Figure 1. Total number of surgeries with one or more complications versus total number of cataract surgeries performed by each resident

The total number of surgeries with one or more complications for each resident was plotted against the total number of cataract surgeries performed by each resident in the simulation and comparison groups. The lower-right quadrant represents lower complication rates, while the upper-left quadrant represents higher complication rates. The simulator group is concentrated in the lower-right quandrant and the comparison group is uniformly distributed across the upper quandrants. In the simulator group, 18% had 0 complications, 55 % had 1 complication, 27% had 2 complications, and none had 3 complications. While in the comparison group, 9%, 9%, 45%, 36% had 0, 1, 2, and 3 complications respectively. 100% of the simulator group had 0–2 complications, while 81% of the comparison group had 2–3 complications. Qualitatively, no individual outliers can be appreciated.