# A Review of Training and Guidance Systems in Medical Surgery
## 5 Conclusions
Interestingly, almost 60% of the works surveyed already incorporate force feedback in their developments. A clue factor for training medical and surgery systems identified in the present research is the incorporation of guidance, assistance, and evaluation features. It is encouraging to notice that a significant advance has been achieved in this regard. 60% of the surveyed sample systems already include guiding during the task, 51% of the developments feature assistance capabilities, and an equal percentage (51%) present evaluation possibilities. Nevertheless, the incorporation of these affordances has still to be increased in future developments to provide students with a closer monitoring and assessment of their task performance. Finally, another major element and opportunity area in the future of the development of Training and Guidance Systems in Medical Surgery, identified in this review, will be the inclusion of AR-VR technologies to the systems. They have a high potential of enriching simulations, providing a complete immersion experience and visual aids or cues that can better guide students when performing a surgery or medical procedure. Regarding the third research question of this paper, asking about the trend of virtual environments and physical applications, it was found that virtual environments comprise almost two-thirds of the systems considered in this study (64%) as compared to the real models. While physical models for surgery were the most feasible options to practice procedures in the past, current advances in computational and visualization technologies have increased the presence of virtual solutions. This trend has broadened the scope of training and guidance systems for medical procedures and has provided new areas of opportunity in simulators' development. Additionally, an exciting finding of this study is that 45% of the researches presented here uses commercial solutions, which in general, are the most complete. From this percentage, 53% are physical workstations composed of physical models and virtual environments to proceed with a surgical task, 30% are CA solutions for planning, or to be used during surgeries, and 17% are virtual environments available in the market. The remaining 55% are solutions were developed by research groups and laboratories across the world. Haptic and visual channels have been privileged in the evolution of the interaction between humans and computers. Advances in the development of haptic devices have allowed companies and researchers to enhance the sense of touch and interaction in surgical simulators' development. Using virtual training environments provides an important alternative to train and gain hand-operated skills. On the other hand, CA and robot-assisted systems provide proper feedback to surgeons, which lets them plan surgeries or execute them with high success rates. Some works limit themselves to recording the session data to evaluate them internally. Others evaluate it and provide immediate user feedback. However, simulators should have the capability to save the entire training process to evaluate students' performance and learning curves. Additionally, by applying AI techniques, in the form of ITs or IAs, these provide guidance and aid during sessions and assess the whole learning process to give detailed feedback to students. Automating the evaluation process could reduce the workload of experts and professors and focus on improving the systems and designing new content. This would undoubtedly assess the potential to increase medical training and guidance systems in medical practices. Conceptualization, D.E.-C., J.N., F.B., and B.B. ; methodology, J.N. and F.B. ; software, D.E.-C.; validation, F.B., L.N., and A.J.M. ; formal analysis, J.N. and A.J.M. ; investigation, D.E.-C.; resources, J.N., F.B., and B.B. ; data curation, D.E.-C., L.N. and J.N. ; writing--original draft preparation, D.E.-C.; writing--review and editing, D.E.-C., J.N., F.B., B.B. and L.N. ; visualization, D.E.-C.; supervision, J.N.