# A Review of Training and Guidance Systems in Medical Surgery
## 3 Methods
### Analysis of the Selected Works
#### 3.7.2 Comparison Analysis  
Table 1 provides an implementation summary of the analyzed works, and it describes their set-up, the type of application, and the type of use. The aspects considered to evaluate the applications were--CS: Commercial Solution, FF: Force Feedback, SM: Stored Metadata, DS: Database Storage, AI: Artificial Intelligence, G: guidance, A: Assistance, and E: Evaluation. PA: Physical Application and VS: Virtual Simulation is mentioned to prove our second hypothesis. Using the information from this table, an evaluation of the presented works was made. First, the eight-dimensional metric of each paper was used to conduct the cluster analysis. Hierarchical clustering with complete linkage to detect similar works, was performed in this study. The clustering was carried out employing the _hclust_ command of R and the euclidean distances of the analyzed works. Then, to obtain the appropriate number of clusters, the best height was selected once the dendrogram was obtained. For the analysis, it happened for \(h=1.7\), and the resulting clusters are in Figure 4. \begin{table}
\begin{tabular}{c c c c c c c c c c c c} \hline \hline
**Area** & **Article** & **Purpose** & **Type** & **CS** & **FF** & **SM** & **DS** & **AI** & **G** & **A** & **E** \\ \hline \multirow{6}{*}{_Arltroscopy_} & [49] & Training & VS & X & X & X & X & & X & X & X \\  & [50] & Surgery & PA & X & & & & & X & \\ \cline{1-1}  & [51] & Surgery & PA & X & & & & & & X & \\ \cline{1-1}  & [52] & Surgery & PA & X & & & & & X & \\ \cline{1-1}  & [53] & Planning & VS & X & & & & & X & \\ \cline{1-1}  & [54] & Training & PA & X & & X & & & X & \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Comparison between applications—Guidance and evaluation aspects. PA: Physical Application, VS: Virtual Simulation, CS: Commercial Solution, FF: Force Feedback, SM: Stored Metadata, DS: Database Storage, AI: Artificial Intelligence, G: guidance, A: Assistance, and E: Evaluation. Figure 3: Distribution of the analyzed papers in terms of their type of use (training, surgery, and planning). \begin{table}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline
Table 2 shows how the analyzed work are grouped according to their cluster and the order presented in Figure 4. Each cluster has its specific characteristics. The first cluster included the simulators described in References [61; 71; 80]. The main characteristic of this group is the use of AI techniques to provide an assessment of user performance. This cluster covers 60% of the AI applications, where the complement can be found in cluster two. Similar to cluster two, this cluster has applications that store metadata. It is worth noticing that most of the applications in this cluster provide guidance, except for Reference [71], and only the work described in Reference [80] implements force feedback. Simulators in this cluster could be considered the next generation of training and guidance applications in medical education. \begin{table}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline
**Alex** & **Article** & **Purpose** & **Type** & **CS** & **FF** & **SM** & **DS** & **AI** & **G** & **A** & **E** \\ \hline \multirow{3}{*}{_Neurosurgery_} & [104] & Training & VS & X & X & & & & & \(\times\) & \(\times\) \\  & [105] & Training & VS & & X & & & & & & \(\times\) \\  & [106] & Training & VS & & X & & & & & & \\ \hline \multirow{2}{*}{_Endovascular Producers_} & [107] & Training & VS & X & & & & & \(\times\) & \(\times\) \\  & [108] & Training & VS & & X & & & & & \(\times\) & \\ \hline _Urology_ & [109] & Training & VS & & X & X & X & & & \(\times\) & \(\times\) \\ \hline \multirow{2}{*}{_Colorectal Procedures_} & [110] & Training & VS & & X & X & & & \(\times\) & \(\times\) & \(\times\) \\  & [111] & Training & PA & X & & X & X & & \(\times\) & \(\times\) & \(\times\) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: _Cont._  
Figure 4: Cluster dendrogram. A hierarchical clustering to generate research groups was performed.