March 2020


Presentation Spotlight
Novel surgical simulator helps develop fine motor skills

by Stefanie Petrou Binder, MD Contributing Writer

The assembled simulator costs less than $50. Individual components are available for download at
Source: Noah Young


Investigators from New York University School of Medicine have developed a low-cost, smartphone-based surgical simulator for ophthalmology training purposes and potential use in developing countries. In an experiment that included surgeons and non-surgeons, the novel simulator was implemented to perform different surgical tasks, including passing a phaco needle through a pupil of decreasing width. The study was shown as an e-poster at the 2019 ASCRS ASOA Annual Meeting.
According to the e-poster’s first author, Noah Young, surgical simulators benefit ophthalmology residents and ultimately patients. “The cost of these simulators, however, is prohibitive to most ophthalmology departments in developing nations. Our objective was to create a useful ophthalmic surgical simulator for fine motor skills training at a cost that is affordable to any residency training program,” he said.

Simulator costs

Mr. Young and his colleagues set a $50 production budget for the entire simulator, including hardware and software. Simulator software was developed using the Unity platform (Unity Technologies), employing smartphone sensors to detect movement. The smartphone was a used Apple iPhone 4S. The hardware element was 3D printed from polylactic acid (PLA) plastic on a LulzBot Mini 2 desktop 3D printer (Aleph Objects). The 3D model design was developed on Fusion 360 (Autodesk).
The material costs included the iPhone 4S ($27.95), the wooden base ($6.99), hardware ($4.11), the PLA filament 98 g plastic substrate ($2.45), an epoxy finish 1 oz ($1.07), and a Lego universal joint ($0.70), resulting in a total of $43.27 for the finished product.
“We have released the software and 3D printer files at, so that anyone can reproduce the simulator,” Mr. Young said.

Simulator experiment

The experimental design included six surgeons, including surgical residents and anterior segment attendings, and 11 non-surgeons, including pre-surgical residents and high school students. After a practice level, each participant performed increasingly difficult tasks ranging from levels 1–4, which consisted of passing a phaco needle through a pupil of decreasing width. The main outcome measures were the number of successful entries though the pupil and the number of complications, defined as inadvertently striking tissue with the phaco needle. The simulator scored successful entry through the pupil as well as accidental trauma to the adjacent tissues.
Surgeons performed superiorly to non-surgeons in passing the phaco needle through the pupil, reaching statistical significance in level 1 (p<.05) and showing a non-significant trend in higher levels. Surgeons also demonstrated fewer collisions with adjacent tissue than non-surgeons (p<.01 for level 1).
“The results of the simulator task demonstrated significant differences in performance between surgeons and non-surgeons, with surgeons demonstrating better performance in the task of passing the phaco needle through the pupil, most significantly at level 1, and showing significantly better performance in avoiding injury to adjacent tissue, also at level 1,” Mr. Young said.
According to the study authors, it is difficult to define which skills distinguish the performance seen among the surgeons from that of the non-surgeons when using this simulator. While researchers think that some part of the distinction is probably due to well-honed fine motor skills, learned caution on the part of experienced surgeons may account for further differences in performance. To the extent that practice on this simulator improves these skills, it may prove a valuable tool for training residents in countries that lack access to expensive full-featured simulators, Mr. Young said.
The Unity platform proved adequate for the production of simulation software that required sufficiently little processing power to be able to run without detectable latency on older smartphones. However, sensitivity to the task was achievable only in three axes, thereby limiting the simulated movement to anteroposterior and lateral directions. The 3D armature was successful in transforming translational movement of the simulated phacoemulsification handpiece to rotational movement detectable by the Unity software.

About the source

Noah Young
Project affiliated with the Department of Ophthalmology New York University
School of Medicine
New York, New York

Relevant disclosures

Young: None



Novel surgical simulator helps develop fine motor skills Novel surgical simulator helps develop fine motor skills
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