Evaluation of ophthalmic surgical simulators for continuous curvilinear capsulorhexis training

Purpose:To evaluate performance and assessments by expert surgeons tasked to create a continuous curvilinear capsulorhexis (CCC) on 3 commercially available surgical simulators.Setting:Montefiore Medical Center Department of Ophthalmology and Visual Sciences, Bronx, New York.Design:Randomized, cross-sectional, comparative study.Methods:Expert cataract surgeons (N = 7) were tasked to create a 5.5-mm CCC on 3 surgical simulators (Bioniko, Kitaro, and SimulEYE). Surgeons rated how well each simulator approximated human tissue on a modified Likert scale (1 to 7). Duration, size, and number of forceps grabs were evaluated.Results:7 surgeons performed a total of 63 trials. Bioniko required a greater number (6.53 ± 3.14) of forceps grabs for CCC creation than Kitaro (4.90 ± 2.47, P =.01) and SimulEYE (3.90 ± 1.34, P <.0001). Surgeons created the 5.5-mm CCC most accurately on Bioniko and SimulEYE, with the largest mean CCC performed on Kitaro (8.00 ± 0.84) compared with that on Bioniko (5.24 ± 0.60, P <.0001) and SimulEYE (5.11 ± 0.41, P <.0001). Surgeons spent more time (seconds) performing the CCC on Bioniko (41.95 ± 26.70) than that on Kitaro (32.05 ± 14.99, P =.02) and SimulEYE (28.90 ± 15.18, P =.002). Kitaro (4.56 ± 0.84, P <.0001) and SimulEYE (4.19 ± 0.92, P <.0001) were rated as more realistic than Bioniko (1.38 ± 0.80).Conclusions:SimulEYE and Kitaro were believed to most closely approximate human capsular tissue, and surgeons performed the CCC fastest on these models. However, surgeons created a 5.5-mm CCC most accurately on SimulEYE and Bioniko. SimulEYE had the best overall performance and fidelity across all studied metrics; however, each simulator demonstrated its own unique advantages and disadvantages. Larger validation studies will help residency programs best use training tools for novice surgeons.