Dissection in the 21^st century: virtual tables versus traditional methods and their influence on medical students’ perception – a systematic review

Abstract

Background

Virtual dissection tables (VDTs) have emerged as innovative tools in anatomy education, offering interactive, three-dimensional visualization of anatomical structures. However, their performance in conjunction with traditional teaching methods needs to be further analyzed and synthesized. This systematic review aimed to evaluate the effectiveness, student satisfaction and perceived utility of VDTs compared to cadaveric dissection, lectures, and textbook-based learning.

Methods

A systematic search of literature identified 22 eligible studies involving students in medicine and related healthcare professions. Studies were analyzed in terms of design, cohort characteristics, educational outcomes, and anatomical content coverage. VDTs evaluated included commercial platforms such as Anatomage, Spectra, VH Dissector, and institutional in-house systems.

Results

VDT use was associated with improved academic performance in 86% of studies, with score increases ranging from 8 to 31% over traditional teaching methods. The greatest improvements were observed in musculoskeletal And neuroanatomy modules. Student satisfaction ranged from 64 to 95%, with the majority citing improved spatial understanding, engagement, And repeatability. However, preference for VDT-exclusive learning remained low, reported by only 2.4–30.2% of students. Most participants favored a hybrid approach combining VDTs with cadaver-based instruction. Despite these benefits, limitations included high implementation costs (up to $200,000 USD), limited access due to device scarcity, lack of tactile feedback, and significant variation in assessment methods and anatomical content. Additionally, no study conducted a direct comparison between various VDT platforms, nor between commercial and in-house systems.

Conclusion

VDTs represent a valuable complement to traditional anatomy education, enhancing learning outcomes and student engagement across a range of healthcare disciplines. However, their full potential is best realized when used as part of a multimodal curriculum that retains cadaveric dissection. Further research is needed to assess long-term outcomes, clinical outcomes and cost-effectiveness, and to compare different VDT systems.

Introduction

Anatomy has long formed the foundation of medical education, providing students with the essential knowledge for safe and effective surgical procedures, but also for interpreting imaging studies and conducting thorough physical examinations. In spite of evolving pedagogical approaches and curriculum structures, anatomy remains a core subject in undergraduate medical programs worldwide [1]. Traditionally, anatomy instruction has relied on cadaveric dissection (formalin-preserved or soft-embalmed), supported by didactic lectures, anatomical models, and textbooks.

However, in recent decades, this method has faced growing challenges, most notably a global shortage of cadaveric donors. A survey conducted by Thengal et al. [2] revealed that 80% of medical students would not wish for their bodies to be donated for Anatomical dissection, raising concerns for the future, as 41% of medical universities in Western countries rely primarily—or even exclusively—on voluntary body donation programs [3]. Additionally, the number of newly admitted medical students each year has increased by 30% over the past decade, And projections suggest that annual admissions could double by 2031 [4]. This trend underscores the rising demand for body donations and thereby widens an existing gap that will require strategic educational solutions to bridge.

In addition to cadaver availability, several systemic challenges have driven the adoption of digital anatomy platforms. These include ethical concerns regarding the use of human remains, health risks such as formaldehyde exposure—reported by 64% of surveyed students—and the rising financial and logistical burden of cadaver maintenance [5]. In academic settings, direct preservation costs typically range from $1,200 to $2,100 per donor, depending on preparation methods and whether services are outsourced, excluding additional expenses such as staffing, facility outfitting, and legal compliance [6]. Moreover, the literature cites curriculum time constraints as a limiting factor for traditional gross Anatomy instruction. For instance, traditional semester-long anatomy courses have seen time reductions of nearly 20%, with some curricula decreasing from 130 to 105 instructional hours [7]. Additionally, cadaver-based learning environments may also induce anxiety or psychological discomfort in some students. For instance, Koney et al. [8] reported that 26.9% of students experienced emotional distress during dissection, And 11.5% reported anxiety or fear before entering the dissection lab. In this context, virtual dissection technologies have emerged as scalable, reusable, and logistically efficient alternatives that address these multifactorial constraints while supporting high-quality anatomical education.

In response to these challenges, universities began adopting technological innovations to modernize anatomical education. Among the various digital teaching tools—such as 3D atlases, virtual reality, and augmented reality platforms, virtual dissection tables (VDTs) have gained increased popularity and are being implemented in medical curricula worldwide. Designed as human-sized touchscreens—either horizontal or vertical—with diagonals ranging from 55 to 81 inches, virtual dissection tables (VDTs) enable interactive, three-dimensional visualization of human anatomy using high-resolution imaging. These platforms allow students to rotate, dissect beyond the traditional three orthogonal planes, and isolate anatomical structures, all without the logistical and ethical constraints associated with cadaver use [9]. The most widely used commercial models include the Anatomage Table (Anatomage Inc., San Jose, California, USA), Spectra (Spectra AB, Linköping, Sweden), and VH Dissector (Toltech Inc., Denver, Colorado, USA). Additionally, several universities have developed their own in-house systems, such as Csanmek (Csanmek Technology, São Paulo, Brazil), Kalbodnama (Tabriz Medical University R&D Center, Tabriz, Iran), and Pirogov (Pirogov Interactive Anatomy, Samara, Russia).

Virtual dissection tables (VDTs) also enable the demonstration of anatomical variations and the examination of how different physiological states—such as pregnancy—may alter standard anatomical relationships among organs. In addition, VDTs offer the possibility to integrate pathological findings within the context of the studies’ anatomical content and to align these with corresponding medical imaging. This feature enhances the transition from basic anatomical education to clinical anatomy, thus supporting a more integrative and clinically oriented approach [10].

Compared to other digital anatomy tools, virtual dissection tables (VDTs) have demonstrated clear superiority in student preference And perceived effectiveness. In a study involving 177 students across four anatomy courses and five teaching modalities (Anatomage Table, 3D Anatomy apps, virtual reality reconstructions, augmented radiographic images, and 3D-printed plastic models), the VDT was consistently the highest-rated tool, preferred over other digital resources by up to 90% of participants [11]. While other tools showed course-specific appeal—such as virtual reality among first-year students and radiographic imaging among postgraduates—the VDT was regarded as the most effective resource across all educational levels and anatomy sub-disciplines, including systemic and regional anatomy, neuroanatomy, and applied musculoskeletal anatomy.

In spite of these advantages, the consensus among educators is that virtual dissection should supplement rather than replace traditional methods. While VDTs provide good visual and interactive learning, they cannot replicate tactile feedback and hands-on skill development provided by cadaveric dissection. Hybrid models—combining cadaver-based labs with digital tools—are increasingly favored to offer a comprehensive, multimodal learning environment [12].

In this context, the proposed systematic review aims to provide a synthesis of the educational value of virtual dissection tables. This includes examining the impact of VDTs on students’ academic performance, as well as exploring their perceptions, satisfaction, and acceptance of these tools as part of the anatomy learning process.

Materials and methods

Two reviewers conducted an extensive search across PubMed, Scopus, and Web of Science (WoS), that focused on the role of virtual dissection tables within undergraduate healthcare Anatomy education. The search was completed in April of 2025. Key words included (but were not limited to): “virtual dissection tables”, “virtual cadaver”, “Anatomage”, “Spectra”, ”VH Dissector”, “medical students”, “medical education”, “anatomy teaching”, “anatomy curriculum”. Due to the relatively recent adoption of digital cadaveric surrogates, our research was limited to papers published in the last decade. To ensure the thoroughness of the search strategy, we searched manually the reference list of each selected paper. Disagreements between reviewers were resolved through deliberation; where consensus could not be established, final arbitration was undertaken by the senior author.

The articles that met the inclusion criteria were those targeting the outcomes of using virtual dissection tables in conjunction with classic anatomy teaching models such as formalin-fixed, soft-embalmed, or plastinated human cadavers, as well as lectures, textbooks or atlases. Only original papers published in peer-reviewed journals, with full-text availability in English were considered for inclusion.

Subsequently, we excluded papers that were flagged as having at least one of the following criteria:

• Full-text manuscripts written in languages other than English.

• Studies focused on veterinary anatomy models.

• Papers designed as systematic reviews, meta-analyses, comments or letters to the editor, and conference abstracts.

• Papers published before 2015.

• Study protocols that aimed to train resident doctors on virtual patients or surgical simulators.

• Research that targeted alternatives to human cadavers other than virtual dissection tables, such as 3D-printed models, 3D atlases, and virtual or augmented reality systems.

• Studies that compared VDT with other teaching auxiliary materials without explicitly including human cadavers.

The search process was synthesized in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) type flowchart (Fig. 1).

Fig. 1.

PRISMA flowchart of the screened and included studies

Results

Study selection and characteristics

The initial search identified 2100 articles, out of which 1293 were processed further after eliminating duplicates. Next, 1193 papers were screened and excluded based on their relevancy to the proposed topic (veterinary anatomy, residency training), language of the manuscript or publication date, leaving 100 papers for the eligibility assessment. Out of them, 78 were further excluded, as 27 were based on augmented or virtual reality systems, 23 on 3D atlases, 14 underwent simultaneous comparison of human cadavers with multiple virtual resources, without clear distinction between the results yielded by each one individually, And 14 aimed to compare virtual dissection tables with other digital or 3D-printed platforms, thus leaving 22 papers for the final analysis.

Of the 22 included studies, 4 focused solely on academic performance, 7 assessed only students’ perceptions And views regarding the integration of the virtual models as stand-alone teaching models or alongside classic methods, while 11 reported both quantitative and qualitative outcomes. Accordingly, results are presented separately for performance analysis and students’ perceptions.

Studies that compared examination results

General characteristics of the selected studies

Based on the inclusion And exclusion criteria, 15 studies that targeted students’ performance assessment through quantitative means have been included (Table 1). Four studies focused on academic outcomes alone, while 11 out of 15 papers conducted an integrative student evaluation, testing both anatomical knowledge and information retention, as well as participants’ views And perceived utility of the virtual dissection tables. The median number of cases was 122 per study, ranging from 16 to 1095. The targeted study program was general medicine in 60% (n = 9) of publications, nursing in 20% (n = 3), while the remaining 20% focused on healthcare-connected domains such as physiotherapy (n = 2) and dental technicians (n = 1). 66.66% of papers (n = 10) conducted their protocols on first year students. In terms of virtual dissection table vendors, Anatomage was the prevalent one, being employed in 86.66% (n = 13) of publications. 60% of protocols compared the efficiency of VDTs to cadaveric specimens in various methods of preservation, while the remaining 40% used lectures, textbooks, And atlases for the control groups. The musculoskeletal system was the most frequently tested subject, as a stand-alone chapter or in conjunction with other subjects in 46.66% (n = 7) of reported protocols, followed by the central nervous system in 33.33% (n = 5), digestive And genitourinary systems in 20% (n = 3) of papers each. Regarding the evaluation method, 66.66% (n = 10) of studies developed an experimental and topic-adapted evaluation, comprised of single/multiple-choice questions or open-ended questions, while the remaining 33.33% (n = 5) used midterm or final practical evaluation scores. For the experimental evaluation methods, the median number of questions asked was 20, ranging from a minimum of 10 questions (open-ended) to a maximum of 100 (single-choice). For the purpose of this review, “academic performance” referred to improvements in test-based outcomes, including pre-test/post-test scores, final examination grades, and overall Grade Point Average (GPA) where available, while “course completion” was defined as successful passage of a course (i.e., receiving credit), regardless of the final score achieved. This distinction was maintained when synthesizing data across studies that reported both quantitative and binary outcome measures.

Table 1.

Main characteristics of the studies comparing anatomy examination results

No.	Author(s), year	No. of participants (n)	Study program, year of study	Type of VDT	Methods used in conjunction with VDT	Specimen preparation	Evaluated topics	Method of evaluation (n = no. of questions)
1.	Patnaik et al., 2024 [13]	96 Control n = 48 Experimental n = 48	Physiotherapy 3rd year	Anatomage	Formalin-preserved specimens	Prosection	CNS	MCQs n = 20
2.	Rathia et al., 2023 [14]	277 Control n = 173 Experimental n = 104	General medicine 1 st year	Anatomage	Human bones	Prosection	Osteology (Humerus radius, ulna)	MCQs n = 15
3.	Boscolo-Berto et al., 2021 [15]	23 Control n = 13 Experimental n = 10	General medicine 2nd year	Anatomage	Textbooks	N/A	Upper limb	Human cadaver dissection
4.	Afsharpour et al., 2018 [16]	1095 Cadaver n = 352 Atlases n = 350 VDT n = 393	Physiotherapy 1 st year	Anatomage	Human cadaver, Plastic models, Atlases	Dissection	MSK	Midterm and final practical examination
5.	* Yoon, 2025 [17]	77 Control n = 35 Experimental n = 42	Nursing 1 st year	Anatomage	Lectures	N/A	MSK, CV, CNS, Digestive	GPA
6.	* Gerardi et al., 2024 [18]	33 Control n = 17 Experimental n = 16	Dental technology 1 st year	Anatomage	Lectures	N/A	MSK, CV, CNS, Respiratory, Digestive, UG, SGS	SCQs n = 40, 1 open-ended question
7.	*Emadzadeh et al., 2023[19]	56 Control n = 29 Experimental n = 27	General medicine 2nd year	Kalbodnama	Lectures, Textbooks, Atlases	N/A	Digestive	MCQs n = 20
8.	* Sultana et al., 2022 [20]	150 Control n = 75 Experimental n = 75	General medicine 1 st year	Anatomage	Human cadaver	Dissection	MSK (Shoulder and hip joint)	GPA
9.	* Bin Abdulrahman et al., 2021 [21]	211 Specimens n = 71 VDT n = 70 Combined n = 70	General medicine 1 st year	Anatomage	Plastinated specimens	Prosection	UG	Open-ended questions n = 10
10.	* Fulmali et al., 2021 [22]	200 Control n = 100 Experimental n = 100	General medicine 1 st year	Anatomage	Human cadaver	Dissection	Head and Neck	Open-ended questions n = 10
11.	*Narnaware et al., 2021 [23]	635 Control n = 132 Experimental n = 503	Nursing 1 st year	Anatomage	Lectures	N/A	Whole curriculum	GPA
12.	* Bianchi et al., 2020 [24]	133 Control n = 109 Experimental n = 24	Nursing 1 st year	Anatomage	Human cadaver, Lectures, Plastinated specimens	Not specified	Whole curriculum	SCQs n = 40
13.	* Baratz et al., 2019 [25]	16 Control n = 8 Experimental n = 8	General medicine 1 st year	Anatomage	Human cadaver	Dissection	MSK, P/P	Open-ended questions n = 37
14.	* Deng et al., 2018 [26]	120 Control n = 60 Experimental n = 60	General medicine 4th year	VH Dissector	Lectures, Textbooks	N/A	CNS	SCQs n = 100, Dissection, Specimen recognition
15.	*Anand et al., 2017 [27]	122 Control n = 61 Experimental n = 61	General medicine 1 st year	Anatomage	Formalin-preserved specimens	Dissection	CNS	MCQs n = 20

VDT Virtual Dissection Table, MSK Musculoskeletal, CV Cardiovascular, CNS Central Nervous System, UG Urogenital, SGS Stomato-Gnathic System, P/P Pelvis and Perineum, GPA Grade Point Average, MCQs Multiple Choice Questions, SCQs Single Choice Questions, N/A Not Applicable

Studies marked with an asterisk (*) represent the papers that focused on both examination results and participants’ perceptions. In the present table, only the examination results of those studies are presented

Short-term outcomes: single and MCQs

Overall, virtual dissection tables outperformed traditional teaching methods such as lectures, textbooks and atlases. Emadzadeh et al. [19] conducted An experimental study on 56 s-year medical students, designed to evaluate the effectiveness of Kalbodnama virtual dissection table in teaching gastrointestinal anatomy. Learning outcomes were assessed through pre-test, post-test, and follow-up multiple-choice question exams. Participants in the VDT group demonstrated a larger increase in test scores from pre-test to post-test (M = − 8.70, p = 0.001) and from pre-test to follow-up (M = − 11.13, p = 0.001), with a substantial effect size (partial η² = 0.84). Additionally, the decline in scores from post-test to follow-up was less pronounced in the VDT group (M = − 2.43, p = 0.007) relative to the textbook group, indicating enhanced knowledge retention.

Likewise, Deng et al. [26] evaluated the implementation of VH Dissector in the study of neuroanatomy And the hypophyseal gland, comparing it to lectures, atlases, and clinical case vignettes. To evaluate the 120 participants, a theoretical test comprised of 100 single-choice questions was administered, followed by a practical evaluation of the quality of their dissection and anatomical landmarks recognition. Students in the digital dissection group scored significantly higher on both theoretical (83.12 ± 6.56 versus 75.57 ± 5.96) and practical assessments (87.23 ± 5.49 versus 83.78 ± 4.64) than those in the control group (p < 0.01). Both examiners And students concluded that the virtual dissection table was superior to traditional tools in terms of repeatability, clear 3D imaging, and integration with clinical case scenarios.

Long-term impact: full-semester studies

Similar results have been reported in studies focusing on healthcare-related educational programs, including nursing and dental technology. Narnaware et al. [23] conducted a semester-long analysis comparing first-year nursing students taught exclusively through traditional lectures versus those who also participated in virtual dissection sessions using the Anatomage Table. The authors found that students exposed to digital dissection achieved significantly higher Grade Point Averages (3.0 ± 0.09 vs. 2.74 ± 0.12, p < 0.05), along with improved midterm performance (p < 0.02), indicating a measurable academic advantage within the same course structure. In a separate study, Gerardi et al. [18] reported higher pass rates And GPAs by 33% among first-year dental technology students who used the VDT compared to peers in traditional lecture-based instruction. However, because the curriculum covered multiple subjects, the authors acknowledged that these GPA differences could not be definitively attributed to Anatomage integration alone.

Likewise, the study conducted by Bianchi et al. [24] on 133 first-year nursing students assessed the final exam performance between students who attended virtual dissection table sessions And those who were traditionally taught using human cadaveric specimens and plastinated models. The average exam score for the VDT group was 26.17/30, compared to 22.91/30 in the non-VDT group, which proved to be of statistically significant difference (p < 0.05). Based on these findings, the pass rate among VDT-attending students was 100%, whereas the pass rate among non-attending students was approximately 87.5%. This reflects a 12.5% higher likelihood of passing the final exam for students who participated in VDT sessions, highlighting that exposure to virtual dissection may contribute not only to improved academic performance but also to enhanced course completion rates.

Anatomy-specific outcomes

When compared to human cadavers or preserved specimens, virtual dissection tables proved their superiority in topics related to the central nervous and musculoskeletal systems, while maintaining non-inferior performance in anatomically complex regions such as the pelvis, perineum, and urogenital apparatus. Regarding the osseous system, Rathia et al. [14] conducted a comparative study to evaluate the effectiveness of the Anatomage Table as a supplementary tool for teaching upper limb osteology, specifically the humerus, radius, and ulna, compared to the use of preserved human bones exclusively. The 15-item multiple-choice questionnaire assessed students’ knowledge of anatomical position, gross features, muscle insertions and relation with nearby neurovascular bundles. Overall, the virtual dissection group scored higher in all three settings, however, statistical significance was reached only for the radius-related test scores (p = 0.021). The largest study on this topic was performed by Afsharpour et al. [16], by Analyzing retrospectively the midterm and final practical examination performance of 1095 physiotherapy students, across three cohorts exposed to different instructional modalities: human cadavers, plastic Anatomical models and virtual dissection tables. While no significant differences were observed in theoretical examination scores across cohorts, final practical examination averages increased from 74.6 to 82% And 85.3% for the cadaver, plastic anatomical models, and VDT groups, respectively (p < 0.001).

In terms of neuroanatomy teaching methods, integrative 3D dissection tools proved objectively more efficient than standard formalin-preserved specimens. The study conducted by Patnaik et al. [13] assessed the effectiveness of the Anatomage virtual dissection table for teaching topics such as the brainstem, cerebellum, cerebrum, and cerebral blood supply, in comparison to traditional specimen dissection, using a 20-item multiple-choice question assessment pre- and post-instruction. Although both groups demonstrated significant improvement between the initial and final evaluations over the six-week period, between-group analysis revealed that the Anatomage cohort scored significantly higher on the post-instruction test (16.93 ± 1.19) than the cadaver group (13.04 ± 2.29), with An associated p-value of 0.0001. Likewise, in the study published by Anand et al. [27], two student groups participated in a 3-hour neuroanatomy session focusing on the spinal cord, basal ganglia, and internal capsule. Group A used the Anatomage Table, while Group B engaged with formalin-preserved specimens. Both groups showed significant improvement from pre-test to post-test (Group A: 7.16 ± 2.06 to 12.5 ± 1.86; Group B: 6.80 ± 2.85 to 11.73 ± 2.49; p < 0.0001 within both groups). Although Group A demonstrated a slightly greater mean improvement, the authors did not report a statistical comparison between groups. Furthermore, baseline knowledge levels were similar, as pre-test scores did not differ significantly (p = 0.315), and the post-test difference also failed to reach statistical significance (p = 0.0979). These findings suggest that the Anatomage Table may support efficient short-term learning, though conclusions regarding superiority should be drawn cautiously in light of the limited exposure duration and lack of intergroup analysis.

Crossover studies

While the aforementioned studies predominantly support the superiority of virtual dissection tables within parallel-group study designs, two studies employed a crossover design, allowing for within-subject comparisons across both cadaveric and digital dissection modalities. Baratz et al. [25] conducted a crossover study with 16 first-year medical students to compare the effectiveness of the Anatomage Table and cadaveric dissection in teaching pelvis and perineum (P/P) and musculoskeletal (MSK) anatomy. Students were divided into groups that alternated between learning each topic via one modality and then being assessed through both (quizzes plus dissection). While quiz scores for P/P did not differ significantly, students in the Anatomage group scored significantly higher on MSK quizzes (p = 0.03). Practical exam performance tended to align with the modality used for instruction—students performed better on the exam that matched their learning method, particularly in P/P evaluation. However, these results have a limited interpretability And reproducibility, as the analysis was performed on 16 participants.

Likewise, the study of Sultana et al. [20] engaged 122 students and assessed the impact of cadaveric and virtual dissection on learning shoulder and hip joint anatomy. students were divided into two groups that alternated between the two modalities for each joint. While both groups demonstrated statistically significant improvement from pre- to post-instruction tests, the Anatomage group consistently achieved higher post-instruction test scores than the cadaver group for both the shoulder and the hip module (8.72 ± 1.45 versus 6.68 ± 1.93 And 8.01 ± 1.53 versus 6.64 ± 2.02, respectively; p < 0.001).

Performance-based testing

In contrast to most previous studies that assessed learning outcomes exclusively through multiple-choice questionnaires, Boscolo-Berto et al. [15] employed a performance-based methodology, requiring participants to complete a cadaveric forearm dissection after preparing with either virtual (Anatomage) or textbook-based materials. Although the experimental group showed higher average scores, the difference between groups was only marginally significant (p = 0.055), likely due to the small sample size (n = 23). Logistic regression Analysis suggested that students trained with Anatomage were 3.75 times more likely to pass the dissection exam (OR = 3.75), though this finding did not reach statistical significance (p = 0.06). Nonetheless, improvements in both 2D And 3D anatomical reporting were noted, suggesting a potential benefit of virtual dissection for enhancing spatial cognition.

Studies that evaluated participants’ perceptions and views

General characteristics of the selected studies

The literature review identified 18 studies that examined students’ user satisfaction with virtual dissection tools implemented alongside traditional anatomy teaching methods (Table 2). Of these, seven studies focused exclusively on participants’ subjective perceptions of learning efficiency, while the remaining 11 assessed both the perceived And objective utility of virtual cadaveric dissection. The median number of participants per study was 127, ranging between 16 And 503. General medicine was the leading study program, reported by 72.22% of papers (n = 13). First year students were involved in 77.77% (n = 14) of the protocols. Anatomage was the leading VDT model, being employed in 66.66% of studies (n = 12). Thirteen studies compared the virtual dissection simulators with formalin-preserved, soft-embalmed, or plastinated human specimens, while the remaining 27.77% (n = 5) assessed VDTs perceived performance in comparison with lectures And textbooks. Once again, the musculoskeletal system was the most frequently evaluated chapter, summarizing 33.33% (n = 6) of the reported protocols, followed by the central nervous system And head and neck topics in 27.77% (n = 5) of the publications. It is worth mentioning that 5 studies (3 conducted on general medicine And 2 on nursing students) chose to evaluate the participants’ perception after using VDTs throughout the whole curriculum. The median number of items in the administered questionnaires was 13, ranging from 3 to 51.

Table 2.

Main characteristics of the studies evaluating the participants’ perceptions

No.	Author(s), year	No. of participants (n)	Study program, year of study	Type of VDT	Methods used in conjunction with VDT	Specimen preparation	Evaluated topics	Questionnaire (n = no. of questions)
1.	Koney et al., [8]	297	General medicine and dentistry 2nd year	Anatomage	Human cadaver	Not specified	Whole curriculum	VDT perceived utility n = 20
2.	Carrillo et al., 2023 [28]	180	General medicine 1 st year	VH Dissector	Human cadaver (formalin-preserved, soft-embalmed, plastinated)	Prosection	Head and Neck	VDT perceived utility n = 13
3.	Funjan et al., 2023 [29]	414	General medicine 1 st – 4th year	Anatomage	Plastinated specimens	Prosection	Whole curriculum	VDT perceived utility n = 14
4.	Ralte et al., 2023 [30]	50	General medicine 1 st year	Spectra	Human cadaver	Prosection	MSK, Thorax, Abdomen, Head and Neck, CNS	VDT perceived utility n = 7
5.	da Silveira et al., 2022 [31]	31	Dentistry 1 st year	Csanmek	Human cadaver	Prosection	TMJ	Learning efficacy and satisfaction n = 10
6.	Alasmari, 2021 [32]	78	General medicine 2nd And 3rd year	Anatomage	Human cadaver	Prosection	Whole curriculum	Learning efficacy and satisfaction n = 6
7.	Darras et al., 2019 [33]	202	General medicine 1 st year	Spectra	Human cadaver	Dissection	Spine, Thorax, Abdomen, Pelvis	VDT perceived utility n = 3
8.	* Yoon, 2025 [17]	77 Control n = 35 Experimental n = 42	Nursing 1 st year	Anatomage	Lectures	N/A	MSK, CV, CNS, Digestive	Learning motivation n = 12 Academic achievement n = 9 Self-efficacy n = 10
9.	* Gerardi et al., 2024 [18]	33 Control n = 17 Experimental n = 16	Dental technology 1 st year	Anatomage	Lectures	N/A	MSK, CV, CNS, Respiratory, Digestive, UG, SGS	Learning efficacy and satisfaction n = 7
10.	*Emadzadeh et al., 2023[19]	56 Control n = 29 Experimental n = 27	General medicine 2nd year	Kalbodnama	Lectures, Textbooks, Atlases	N/A	Digestive	Learning efficacy and satisfaction n = 16
11.	* Sultana et al., 2022 [20]	150 Control n = 75 Experimental n = 75	General medicine 1 st year	Anatomage	Human cadaver	Dissection	MSK (Shoulder and hip joint)	VDT perceived utility n = 4
12.	* Bin Abdulrahman et al., 2021 [21]	191	General medicine 1 st year	Anatomage	Plastinated specimens	Prosection	UG	VDT perceived utility n = 15
13.	* Fulmali et al., 2021 [22]	200 Control n = 100 Experimental n = 100	General medicine 1 st year	Anatomage	Human cadaver	Dissection	Head and Neck	VDT perceived utility n = 6
14.	*Narnaware et al., 2021 [23]	503 (just the experimental group)	Nursing 1 st year	Anatomage	Lectures	N/A	Whole curriculum	Learning efficacy n = 21
15.	* Bianchi et al., 2020 [24]	133 Control n = 109 Experimental n = 24	Nursing 1 st year	Anatomage	Human cadaver, Lectures, Plastinated specimens	Not specified	Whole curriculum	VDT perceived utility n = 11 Anxiety evaluation n = 40
16.	* Baratz et al., 2019 [25]	16 Control n = 8 Experimental n = 8	General medicine 1 st year	Anatomage	Human cadaver	Dissection	MSK, P/P	Self-efficacy n = 6
17.	* Deng et al., 2018 [26]	60 (just the experimental group)	General medicine 4th year	VH Dissector	Lectures, Textbooks	N/A	CNS	Learning efficacy n = 20
18.	*Anand et al., 2017 [27]	122 Control n = 61 Experimental n = 61	General medicine 1 st year	Anatomage	Formalin-preserved specimens	Dissection	CNS	VDT perceived utility n = 10

VDT Virtual Dissection Table, MSK Musculoskeletal, CV Cardiovascular, CNS Central Nervous System, UG Urogenital, SGS Stomatognathic System, P/P> Pelvis and Perineum, TMJ Temporomandibular Joint, N/A Not Applicable

Studies marked with an asterisk (*) represent the papers that focused on both examination results and participants’ perceptions. In the present table, only the perceptions’ qualitative assessment of those studies is presented

Perceived utility and user satisfaction

Overall, participants provided positive feedback regarding the use of virtual dissection tools. Most surveys focused on perceived utility and self-reported learning effectiveness. In the survey administered by Koney et al. [8] following the completion of the entire curriculum, 69.2% of students agreed that the Anatomage Table enhanced their understanding of internal structures and organ relations, and 82.7% supported its continued use in anatomy teaching. Carrillo et al. [28] reported strong satisfaction metrics as well, with 95.1% valuing the reusability of the VH Dissector And 90.8% highlighting the repeatability of digital tasks. Similarly, da Silveira et al. [31] found that 88% of the students studying dentistry on the Csanmek virtual dissection table believed the digital tool improved their understanding of temporomandibular joint Anatomy, and 82% felt it supported long-term memory. Likewise, Alasmari et al. [32] found high user satisfaction, with 73% of students reporting that they perceived the Anatomage Table as a useful tool for enhancing active learning during practical sessions. Collectively, these findings point to a strong perceived educational value and user satisfaction associated with virtual dissection technologies.

Motivation and engagement

Across the reviewed studies, virtual dissection tools were consistently associated with enhanced student motivation to engage with anatomy content. In multiple cohorts, students reported increased enthusiasm, enjoyment, and curiosity when interacting with virtual dissection platforms. In the paper published by Funjan et al. [29], 64.3% of students reported that Anatomage improved their comprehension of anatomical lectures, while 64% reported it helped with long-term memorization. Sultana et al. [20] also documented heightened motivation, with 93.3% of students reporting that three-dimensional visualization improved their learning engagement, while Bianchi et al. [24] concluded that the use of virtual dissection increased participants’ interest in studying Anatomy in 71% of cases—particularly among those who previously struggled to engage with static models or traditional lab formats. Moreover, in the study conducted by Darras et al. [33], 78.7% of students reported that virtual sessions enhanced their attentiveness and understanding of cadaveric anatomy, thus highlighting the need for a shift in the paradigm and an adapted curriculum to the current tech-savvy generation of students.

However, students’ learning efficacy self-assessment is not always reflected in the quantitative analysis of their examination scores. In the study published by Anand et al. [27], students in the Anatomage group reported high satisfaction and perceived the tool as academically beneficial; however, while their post-test scores were slightly higher than those in the cadaver group (12.5 versus 11.73), the difference did not reach statistical significance (p = 0.0979). This suggests that perceived utility did not directly correspond to a measurable academic advantage. A similar pattern emerged in the study group of Baratz et al. [25], where students expressed strong enthusiasm for the Anatomage Table and performed better on assessments aligned with the tool they had used for learning; however, the advantage appeared to reflect modality-specific familiarity rather than an absolute gain in anatomical knowledge. Students who learned via virtual dissection scored higher on digital practical exams, while cadaver-trained students performed better on traditional formats, indicating that perceptions of academic value may be context-dependent.

Anxiety and emotional stress

Regarding learning and cadaver-induced anxiety, several studies reported a reduction in student stress levels associated with the use of virtual dissection tools. The most comprehensive study targeting this topic was the one conducted by Bianchi and colleagues [24]. The authors used the 40-item State-Trait Anxiety Inventory (STAI) on 133 first-year nursing students, to assess their stress levels for partaking into cadaveric dissection And expressed anxiety for the future examinations. 78% of students indicated that the Anatomage Table helped alleviate discomfort related to cadaveric dissection. In addition, students who used the table had significantly lower pre-exam anxiety scores (STAI = 46.5 ± 10.03) compared to those who did not (STAI = 52.3 ± 9.53; p < 0.05).

Similarly, Yoon et al. [17] found a significant improvement in emotional preparedness, with students in the VDT group showing a 2.64-point increase in self-confidence (from 28.74 to 31.38), while the control group experienced a 0.71-point decrease (from 28.54 to 27.83; p = 0.001). Likewise, in the cross-sectional survey by Koney et al. [8], several students expressed discomfort And emotional stress associated with cadaveric dissection, particularly during their initial exposure, identifying Anatomage as a less stressful and more approachable alternative, especially early in the curriculum in 37.71% of cases, as responders attributed to its hygienic, odorless environment and the absence of physical handling of human remains, which some students found distressing.

Perceptions of replacement versus supplement

Lastly, while VDTs received broadly positive evaluations across literature, there was no unanimous support among students for fully replacing traditional cadaveric dissection, rather a strong consensus emerged that virtual dissection tools are best suited as complementary resources for anatomy education. Although students were somewhat distressed by human cadavers handling, Koney et al. [8] concluded that 87.9% of students opposed complete replacing cadaveric dissection with the Anatomage Table, and 85.6% explicitly preferred a hybrid approach. Similarly, Ralte et al. [30] reported that 96% of students agreed that virtual dissection should serve as a supplementary tool, And 100% preferred a combined methodology. These results were supported by Funjan et al. [29], reporting that only 30.2% of students preferred using Anatomage alone, whereas 80.5% favored a blended strategy integrating traditional resources. Moreover, the study by Boscolo-Berto et al. [15] further reinforced this stance, especially in the context of students training on the Anatomage Table and being evaluated by their human cadaver dissection skills. Although 70% of the students who used the Anatomage Table found it beneficial for visualizing 3D relationships, traditional gross dissection was still unanimously regarded as the pivotal method for learning anatomy. Students acknowledged the preliminary usefulness of VDTs in preparing for cadaver-based sessions but did not support their use as a standalone solution. Collectively, these findings reflect a clear student preference for hybrid instruction, in which virtual tools enhance—but do not substitute—the tactile, spatial, and detail depth offered by cadaveric dissection.

Discussion

Virtual dissection tables represent valuable anatomical teaching tools that encourage interactive learning and foster spatial understanding through high-resolution, three-dimensional visualization of organs and structures. They further allow the integration of clinically relevant data, thereby reinforcing the correlation between a robust foundational knowledge of anatomy and effective clinical practice.

Across literature, VDTs proved superior to conventional dissection and teaching methods by enhancing students’ academic performance, while reducing learning-related anxiety. Chytas et al. [34] provided a descriptive overview of virtual dissection technologies in Anatomy education, focusing primarily on implementation considerations such as technical integration and curricular adaptation. While the review acknowledged the educational value of VDTs, it did not assess individual studies for objective learning outcomes or comparative effectiveness. By contrast, our review includes 22 studies and focuses specifically on outcome-based comparisons, with the majority of them reporting statistically significant improvements in student test scores following VDT integration, offering a clearer picture of the measurable educational impact.

Similarly, Said Ahmed et al. [10] reviewed 11 studies in a Cureus article, concluding that 64% of their included studies demonstrated improved outcomes with VDT use. However, their analysis did not consistently distinguish between perceived utility (i.e., self-reported satisfaction) and objective performance measures (e.g., test scores). In our review, this distinction was central: we separately categorized And analyzed studies reporting improved academic performance versus those reporting only positive perception. Furthermore, 73% of the studies we included reported high levels of user satisfaction, often alongside objective academic gains. This approach not only validates some of Said Ahmed’s findings but also adds clarity by specifying the nature and direction of those benefits.

Numerous studies included in the present paper have demonstrated that students taught using virtual dissection tables consistently outperform those in control groups, with reported performance improvements ranging from 8 to 31% across various anatomical topics. The most substantial gains were observed in musculoskeletal anatomy, where Sultana et al. [20] reported a 30.5% higher post-test score for students learning about major limb joints using the Anatomage Table compared to those using traditional cadaveric dissection. Similarly, in neuroanatomy, Patnaik et al. [13] found up to a 23% improvement in scores among students studying brainstem, cerebellum, cerebrum, and cerebral vasculature using VDTs. In contrast, more anatomically complex or spatially intricate regions—such as the urogenital system and the pelvis and perineum—tended to show more modest gains, typically ranging between 7% And 10% [21]. When applied across entire academic curricula, VDT integration was associated with pass rates as high as 100%, compared to 87.5% in the control group, and statistically higher GPAs (p < 0.05) [23]. These findings suggest that VDTs are not only effective for isolated modules but also yield sustained academic benefits when embedded throughout the curriculum.

In terms of subjective evaluation, students’ perceptions of virtual dissection tables were overwhelmingly positive across the included studies, with reported overall user satisfaction And self-assessed learning benefits ranging from 64 to 95%. In terms of perceived utility, 64.3–95.1% of students agreed that VDTs improved their understanding of anatomical content and facilitated better retention [28, 29]. Motivation And engagement were also significantly impacted, with 71–93.3% of students reporting increased interest and enthusiasm for anatomy following VDT use [20, 24]. From a mental health perspective, anxiety reduction was another consistent theme, as Bianchi et al. [24] showed that 78% of students found VDTs helpful in alleviating stress associated with cadaveric dissection, while STAI scores were significantly lower in the experimental group for the pre-examination anxiety assessment (46.5 ± 10.03 for the VDT group versus 52.3 ± 9.53 for the non-VDT group, p < 0.05). Moreover, the validity of these findings is further strengthened by the fact that the highest satisfaction levels were reported in studies evaluating VDT use across the entire anatomy curriculum over the course of an academic year.

Virtual dissection tables have demonstrated strengths such as dissection repeatability And adaptability. By having structures annotated and step-by-step instructions available for each region, 68–80% of students acknowledged the time-saving benefit of bypassing the physical dissection of successive tissue layers, which allowed more focus on identifying and memorizing structures [8]. Additionally, virtual platforms promote didactic independence by shifting the learning model from teacher-centered to student-centered, fostering self-directed study and encouraging peer-to-peer tutoring [35].

However, certain limitations must be considered when implementing a fully digitalized anatomy laboratory. One of the primary concerns raised by participating students was the absence of tactile feedback, a factor especially relevant when virtual dissection tools are compared to cadaver-based instruction. While haptic rendering has been successfully integrated into virtual surgical simulators [36], current dissection tables lack such enhancements. Although many studies included in this review compared Anatomage to non-haptic modalities such as textbooks, models, or lectures, the broader debate around digital anatomy education frequently highlights the irreplaceable tactile experience offered by human cadavers. Reflecting this, up to 68.5% of students expressed a preference for the realistic environment provided by cadaveric dissection, particularly valuing its true-to-life nature and tactile authenticity [9]. From a logistic point of view, the cost of a fully equipped commercial VDT can start at $85,000 to $100,000 USD for the Anatomage Table and can reach as high as $200,000 USD for a full-option Spectra Dissection platform [8]. Furthermore, institutions must consider the number of units required to support effective instruction, as studies indicate that the optimal group size per VDT session ranges between 8 And 15 students [18, 33]. Notably, most studies reported access to only a single VDT, with only Yoon et al. [17] and Emadzadeh et al. [19] indicating the availability of two or more devices on campus. Consequently, students were typically grouped And allotted 15 to 30 min of interaction time per session, leading to reported limitations in training: 51% of students cited restricted training time, while 39% reported insufficient access to the VDT [8]. Additionally, Boscolo-Berto et al. [15] reported minor technical limitations that could interfere with day-to-day teaching activities, such as system lag, reduced image resolution at maximum zoom, and the restriction of interaction to a single user at a time—factors that were associated with off-task behaviors as noted by the teaching staff.

While ethical concerns regarding cadaveric dissection—such as informed consent, cultural sensitivities, and legal compliance—are well acknowledged, similar scrutiny must be applied to digital anatomy resources. Many widely used virtual dissection tables, including the Anatomage Table and Sectra Table, are built upon datasets from the U.S. National Library of Medicine’s Visible Human Project. The male dataset was generated using the body of an executed prisoner who had consented to body donation, though questions have been raised about the voluntariness and transparency of the consent process [37]. These concerns underscore the need for ethical vigilance, even in digital contexts.

Moreover, as highlighted by the International Federation of Associations of Anatomists (IFAA) in their 2024 recommendations, the use of anatomical images—digital or otherwise—must adhere to ethical standards regarding consent, data provenance, and cultural respect [38]. This is especially relevant given that selected studies included in our review employed institutionally developed digital tools without disclosing the origin or consent framework of the underlying anatomical data. The absence of such disclosure raises important questions about privacy, representation, and the potential commodification of human remains in digital formats.

Although encouraging overall, the generalization of the conclusions drawn from these publications is hindered by a series of factors, as the studies included in this review exhibited considerable heterogeneity across multiple dimensions. First, the cohorts varied in size and professional background, encompassing general medicine students as well as learners from allied health disciplines such as nursing, dental technology, and physiotherapy. This diversity highlights the broad applicability of virtual dissection tables across healthcare education but also introduces variability in baseline anatomical knowledge and curricular expectations. Second, the methods used to assess VDT utility were inconsistent, ranging from pre- and post-intervention multiple-choice question tests to GPA comparisons, Likert-scale satisfaction surveys, and performance-based assessments such as forearm dissection [15]. Third, the reference standards against which VDTs were compared differed substantially: some studies used cadaveric dissection as the primary comparator, while others relied on lectures, textbooks, plastic models, or combinations thereof. The anatomical content evaluated also varied significantly—from focused topics such as one or two joints, shoulder and hip, or the temporomandibular joint to complex systems like the central nervous or urogenital systems, and in some cases, the entire anatomy curriculum. Notably, no study conducted a direct, head-to-head comparison between different commercial VDT platforms, like Anatomage versus Spectra dissection tables or between commercial and in-house virtual dissection platforms, thus limiting conclusions about the relative performance of specific technologies.

Lastly, a consistent theme across the reviewed literature is the endorsement of a hybrid approach that combines virtual dissection tables with traditional cadaveric dissection. Multiple studies emphasized that, while they recognized the pedagogical value and technological advantages of VDTs, students did not support the elimination of cadaver-based instruction. In the study conducted by Koney et al. [8], 87.9% of students explicitly opposed a fully digital anatomy lab, while Ralte et al. [30] reported that 96% preferred VDTs as a supplement rather than a standalone tool. This was consistent across all studies and further emphasized by the relatively low proportion of students who, if given the option, preferred cadaver-free and VDT-exclusive training—ranging from 2.4 to 30.2% [29]. Overall, there was clear agreement that the integration of both methods provides a more comprehensive and effective educational experience, one that balances spatial understanding, emotional readiness, and technical proficiency in anatomical science.

Limitations

In addition to methodological heterogeneity, some structural And contextual limitations should be acknowledged. Most studies included in this review relied on single-center data with small to moderate sample sizes, limiting the external validity of their findings. Furthermore, few studies have assessed long-term retention or clinical translation of anatomical knowledge acquired through VDTs, leaving the durability and practical relevance of learning gains uncertain. Access to virtual dissection tables was also frequently restricted, with only one unit available at most institutions and students grouped in sessions ranging from 8 to 15 learners—often with limited interaction time per session. This restricted access may have influenced both academic outcomes and student satisfaction. Lastly, while students’ perceptions were positive overall, most data were collected using self-reported surveys, which are inherently subjective and prone to response bias.

Conclusion

Virtual dissection tables have emerged as prominent educational tools that enhance spatial understanding, student engagement, and academic performance in anatomical education. Their integration into the curriculum is associated with increased motivation, reduced dissection-related anxiety, and improved examination outcomes, particularly in musculoskeletal and neuroanatomy modules. However, VDTs are not without limitations—chiefly their lack of tactile feedback, high implementation costs, and limited availability per student. Across the reviewed studies, a strong consensus was observed in favor of a hybrid instructional model, combining the visual and interactive advantages of VDTs with realism and tactile experience of cadaveric dissection. Taken together, these findings support the integration of virtual dissection as a complementary, but not substitutive, component of anatomy education, especially when aligned with clinical reasoning and multi-modal learning strategies. 

Authors’ contributions

T.T. and R.-D. C. were in charge of the conceptualization.T.T. and M.B. did the literature review and PRISMA flowchart.T.T. and R.-D. C. prepared the original draft of the manuscript.G.A.F. and C.-B. C. reviewed and corrected the the drafted manuscript and supervised the project.All authors have read and agreed to the published version of the manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable. This study is a systematic review of previously published research and did not involve direct human participants, interventions, or data collection. As such, no ethics approval or consent to participate was required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.