Simulator Found to be Effective Training Tool in Cleft Palate Surgery

Alyssa KirkmanACPA News

  • Surgeon’s level of experience reflects economy of hand motion
  • Simulator offers effective environment for cleft palate surgical training

CHAPEL HILL, N.C. / April 25, 2019 – A high-fidelity cleft palate simulator can provide an effective training environment for cleft palate surgery while assessing participants’ economy of hand motion and level of expertise, according to the article “Economy of Hand Motion During Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator” published in the March 2019 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“Cleft-palate surgery is technically demanding, and challenging to teach and learn,” said Ali Ghanem, MD, PhD, FRCS, lead researcher. “And, since surgical outcomes depend on the surgeon’s level of experience, simulation technology can help improve patient care without compromising patient safety.”

Two first-year residents in plastic surgery, one fellow in pediatric plastic surgery, one fellow specializing in cleft surgery, and two expert plastic surgeons specializing in cleft surgery participated in the study. Electromagnetic (EM) tracking sensors attached to each surgeon’s hands determined the time, number of hand movements, and total distance the hands traveled while performing a von Langenbeck cleft palate repair.

Study participants represented a range of expertise with cleft palate repair. Both residents had no previous cleft palate repair experience and were therefore each given a two-hour didactic teaching session on the procedure prior to participating in the simulation session. Each fellow had performed five repairs independently. One plastic surgeon had done 100 repairs and the other had performed 850 repairs.

The average number of hand movements during the procedure was higher for the residents, compared to the fellows and plastic surgeons. “These results demonstrate that those with more previous experience performing cleft palate repair have overall better economy of hand motion,” Dr. Ghanem explained.

“Surgeons and airline pilots share many important characteristics- both perform complex maneuvers after prolonged training and, when mistakes happen, serious consequences can result including loss of lives. Pilots undergo hundred of hours of simulator training before they actually fly a real commercial jetliner full of passengers. Now simulators are progressively being applied to surgical training as well,” states Jack C. Yu, DMD, MD, MS ED, Editor of CPCJ. “This article not only validates the effectiveness of the simulation but it also, by tracking precise hand motions, allow the decomposition of complex operations into their component parts. This is the necessary first step that can lead to, in addition to better surgeons, perhaps surgical robots in the distant future.”

The study’s small sample size limits the researchers’ ability to draw definitive conclusions, so this research is descriptive in nature. However, the study does offer insight into the amount of training needed to achieve a near-expert level of proficiency in cleft palate repair, as well as a competency-based foundation for curriculum design, assessing surgeons’ skills, and certification. Overall, the study’s researchers concluded that the simulator is a valid and effective training tool in cleft palate surgery.

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit