# A Review of Training and Guidance Systems in Medical Surgery
## 3 Methods
### Synthesis of the Selected Works
#### 3.8.10 Open Surgery  
Suturing is one of the fundamental skills that all doctors should perform adequately. Authors, such as [PERSON] et al., have started to generate in-house solutions to help trainees train suture [98]. Their platform uses a Geomagic Touch haptic device, a pair of Crystal Eyes 3D glasses, sold by StereoGraphics, a stereo synchronization emitter, a semitransparent mirror, and a metal frame. To provide a realistic approach, different needle shapes can be used during the simulation. The software was developed using the Reachin API, custom classes, and objects. To evaluate the user, time to complete the task, entry and exit tear size area, penetration, exit angles, tool movements, average grasp number, and motion smoothness are considered to calculate a task score, which is stored in a performance database. The system also gives immediate feedback and objective measurement of performance during the simulation to let the trainees compare and improve their techniques. Venipuncture is another typical procedure. It is the process of obtaining intravenous access for venous blood sampling or intravenous therapy. Wrong techniques increase the discomfort of patients and can delay therapeutics or testing. Therefore, solutions have arisen in the market to cover venipuncture training. [PERSON] and [PERSON] evaluated a commercial haptic-based clinical training system made by UK Haptics Limited [99]. The system consists of a Reachin Display, a pair of StereoGraphics CrystalEyes 3D glasses, and one Geomagic Touch haptic device. This simulator consists of two modules--training management (Clinical Skills Trainer) and a training solution (Virtual Veins). Each user has a personalized account, which lets the simulator monitor their progress through time. After a practice or test session, a report is generated. The report enables the user to reflect on their performance and allows the user, and teaching staff, to review student's performance after testing. Innovations in the area of mobile learning are usually in the form of applications or courses. One new use in the market is Touch Surgery [100]. Kinosis LTD developed this application for iOS and Android. It is a freeware that allows users to simulate over 30 common operations on a mobile device. It provides orientation and instructions when the user is performing a simulated operation. It will enable trainees to affect each task cognitively; thus, students build awareness of potential complications and procedure experience. The application counts with a progress module, that provides scores and evaluates users' knowledge as they work. Low-cost training solutions have been pursued in all areas. In aortic root surgery, [PERSON] et al. created a portable, inexpensive, reusable simulator [101]. The cost of the total simulator is a little more than 1 USD. The simulator consists of a 9.5 cm diameter x 4 cm height thin box with holes in it to place an aortic root silicone replica. The simulator also guides training by putting a circular ring. This ring was designed using cardboard, and it has fifteen to twenty cuts to help the user during the process. [PERSON] et al. developed the solution to be performed in every kind of aortic valve root repair specified in [PERSON]'s classification. Procedures that can be achieved are--excision of a diseased aortic valve, sizing the valve, and replacement of different aortic valve types (interrupted, semi-continuous, sutureless, and stainless) using circular or oblique aortotomy. A common area in surgery is tumor removal. On the liver, it is usually treated using hepatic resection; nevertheless, radiofrequency ablation is another good alternative. It requires accurate needle insertion and precise hand-eye coordination. To solve this issue, [PERSON] et al. built a cooperative robot station that uses hand gesture controls and AR [46]. AR is used as a guidance mechanism. It is generated using a projector, sold by ProCam, to create an overlay on the patient's body, where pre and intraoperative information is displayed.