Low-Fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies

Can a Low-Fidelity Arthroscopic Simulator Improve Technical Expertise in Performing Temporomandibular Joint Arthroscopy?

BACKGROUND

Challenges in temporomandibular joint (TMJ) arthroscopy training include the cost of operating room time, surgical risks, and the accessibility of cadavers and high-fidelity simulators. A low-fidelity simulator (LFS) was developed for initial TMJ arthroscopy training.

PURPOSE

The aim of this study was to evaluate improvement in TMJ arthroscopic skills after training with an LFS using the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale.

STUDY DESIGN, SETTING, SAMPLE

A prospective randomized controlled study was conducted. Subjects included Oral and Maxillofacial Surgery residents in postgraduate year 1-5 at Thomas Jefferson University. Chief residents actively performing TMJ arthroscopy were excluded.

PREDICTOR VARIABLE

The predictor variable was participation in LFS training. Subjects were randomly assigned to the LFS training or no LFS training group.

MAIN OUTCOME VARIABLES

The primary outcome variable was simulated surgical skill measured by total ASSET score (maximum score of 35). The secondary outcome variables were simulated surgical skill measured by each ASSET domain score and time to completion.

COVARIATES

The covariates included sex, age, handedness, postgraduate year, endoscopic experience, open TMJ surgery experience, and experience with musical instruments and sports.

ANALYSES

Data analyses included paired T-tests to determine changes in outcome variables after TMJ arthroscopy training between experimental groups, and ANOVA and χ2 tests to identify associations between covariates. Inter-rater reliability of the blinded examiners was evaluated using Cronbach's alpha correlation. A P-value < .05 was considered significant.

RESULTS

The sample was composed of 10 residents: 5 (100%) males in the no LFS group, 3 (60%) males, and 2 (40%) females in the LFS group (P = .4). There was no significant difference between the groups in pre-TMJ arthroscopy training ASSET scores (P = .3). After training, the total ASSET score improved by 3.40 ± 6.87 in the no LFS group and by 6.27 ± 2.68 in the LFS group (P = .03).

CONCLUSIONS AND RELEVANCE

Study results showed that low-fidelity simulation can improve fundamental arthroscopic skills. Future research should be conducted on a larger scale to further validate this model and show the transfer of skill improvements to cadaver and live patient settings.

Arthroscopic Training: Historical Insights and Future Directions

Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred surgical approach for treating various orthopaedic pathologies, such as meniscal tears, anterior cruciate ligament ruptures, rotator cuff tears, and wrist, elbow, ankle, and hip conditions. Despite its ubiquity, surgical training in arthroscopy poses several challenges for educators and trainees. Arthroscopy involves neuromotor skills which differ from those of open surgery, such as the principles of triangulation, bimanual dexterity, and the ability to navigate a three-dimensional space on a two-dimensional screen. There remains no universally implemented curriculum for arthroscopic education within orthopaedic residency or fellowship training programs, permitting the potential for highly variable training experiences from institution to institution. Therefore, the current review seeks to highlight the history of arthroscopic education, strategies and current teaching modalities in modern arthroscopic education, and avenues for future educational pathways.

Application of Virtual Reality Systems in Bone Trauma Procedures

Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation.

Use of a Dry Surgical Simulator Improves Orthopaedic Residents’ Competency and Technical Skills for Arthroscopic Rotator Cuff Repair

Purpose

Methods

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Clinical Relevance