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Alt PS, Hamacher D, Anetzberger H, Becker R. Movement-based cognitive training does not significantly shorten the learning curve for acquiring arthroscopic basic skills. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38971975 DOI: 10.1002/ksa.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Skilful arthroscopy requires an aboveaverage level of manual dexterity. It is evident that particular motor skills can be learned and trained before arthroscopic training. The aim of this prospective cohort study was to investigate the impact of movement-related cognitive training on the learning curve during arthroscopic basic training. METHODS Fifty right-handed participants without arthroscopic experience were matched to an intervention group (n = 25) and a control group (n = 25). Prior to basic arthroscopic skill training with a simulator, the intervention group underwent 12 weeks of movement-related cognitive training. Cognitive and motor skills were assessed in both groups by using standardised tests (CogniFit test, angle reproduction test, two-arm coordination test) as a pretest and, for the intervention group, again before arthroscopic training as a posttest. For arthroscopic simulator training, three tasks ('Telescoping', 'Periscoping', 'Triangulation') from the Fundamentals of Arthroscopic Surgery Training module were selected and practiced 10 times with the camera in the right and left hands. The learning progress was quantified by exercise time, camera path length and hook path length. RESULTS No significant differences in sex distribution, age distribution or the results of the pretests between the intervention group (n = 21) and the control group (n = 25) were found (n.s.). The intervention group improved significantly from the pretest to the posttest in the CogniFit (p = 0.003) and two-arm coordination test in terms of time (p < 0.001) and errors (p = 0.002) but not in the angle reproduction test. No significant differences were found between the groups for the three arthroscopic tasks. CONCLUSION The hypothesis that movement-related cognitive training shortens the learning curve for acquiring arthroscopic basic skills cannot be confirmed. Other factors influencing the learning curve such as talent, teaching method and motivation have a greater impact on the acquisition of complex motor skills. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Prisca S Alt
- Department of Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Dennis Hamacher
- Department of Health Sciences, European University of Applied Sciences (EUFH), Rostock, Germany
| | | | - Roland Becker
- Department of Orthopaedics & Traumatology, University Hospital Brandenburg, Brandenburg, Germany
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Tronchot A, Maximen J, Casy T, Common H, Thomazeau H, Jannin P, Huaulmé A. The influence of virtual reality simulation on surgical residents' heart rate during an assessment of arthroscopic technical skills: A prospective, paired observational study. Orthop Traumatol Surg Res 2024:103915. [PMID: 38857823 DOI: 10.1016/j.otsr.2024.103915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 06/12/2024]
Abstract
HYPOTHESIS To demonstrate that a virtual reality (VR) simulation training program reduces heart rate variability during an assessment of surgical trainees' technical skills in arthroscopy. STUDY DESIGN Prospective observational matched study. MATERIALS & METHODS Thirty-six orthopaedic surgery residents, new to arthroscopy, received standard training in arthroscopic knee surgery, supplemented by additional monthly training for 6months on a VR simulator for 16 of them. At inclusion, the 2 groups (VR and NON-VR) answered a questionnaire and performed a meniscectomy on a VR simulator. After 6months of training, two independent trainers blinded to the inclusion arms evaluated the technical skills of the two groups during meniscectomies on a model and on an anatomical subject. Heart rate variability (HRV) was measured using a wireless heart rate monitor during baseline, VR training, and assessment. RESULTS After removing incomplete data, the analysis focused on 10 VR residents matched at inclusion with 10 NON-VR residents. The VR group had a significantly lower heart rate at the final assessment (p=0.02) and lower overall HRV (p=0.05). The low/high frequency ratio (LF/HF) was not significantly different between the groups (1.84 vs 2.05, p=0.66) but the before-after training comparison showed a greater decrease in this ratio in the VR group compared to the NON-VR group -0.76 (-41%) vs -0.08 (-4%). CONCLUSION This study demonstrates a significant difference in heart rate variability between trained residents versus untrained residents during the final assessment of their technical skills at 6months. It appears that improving stress management should be an integral part of training programs in arthroscopic surgery. CLINICAL INTEREST VR simulators in arthroscopy could improve non-technical skills such as heart rate variability, from the perspective of accountability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexandre Tronchot
- Université de Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Julien Maximen
- Orthopaedics and Trauma Department, Rennes University Hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Tiphaine Casy
- Université de Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Harold Common
- Orthopaedics and Trauma Department, Rennes University Hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Hervé Thomazeau
- Université de Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Pierre Jannin
- Université de Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Arnaud Huaulmé
- Université de Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
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De Luca P, Di Stadio A, Scarpa A, Ricciardiello F, Viola P, Radici M, Camaioni A. 3-D virtual reality surgery training to improve muscle memory and surgical skills in head and neck residents/young surgeons. Eur Arch Otorhinolaryngol 2024; 281:2767-2770. [PMID: 38436755 DOI: 10.1007/s00405-024-08573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Affiliation(s)
| | | | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Pasquale Viola
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Marco Radici
- Otolaryngology Department, Gemelli Isola, Rome, Italy
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
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Flores MJ, Brown KE, MacKechnie MC, O’Marr JM, Rodarte P, Shearer DW. An Analysis of Participant Preferences Regarding Virtual Versus In-person Format of Orthopaedic Surgery Educational Materials in Low- and Middle-Income Countries. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00003. [PMID: 38437056 PMCID: PMC10906641 DOI: 10.5435/jaaosglobal-d-23-00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The University of California, San Francisco Institute for Global Orthopaedics and Traumatology Surgical Management and Reconstructive Training (SMART) course has instructed orthopaedic surgeons from low-resource countries on soft-tissue reconstruction. Before the COVID-19 pandemic, the course was conducted in-person; however, it was transitioned to a virtual format during the pandemic. The aim of this study was to determine participant preferences regarding a virtual or in-person SMART course format. METHODS Survey data were collected via e-mail after each SMART course using RedCap or Qualtrics. Statistical analyses were conducted using Stata. RESULTS There were 247 survey respondents from 44 countries representing all world regions, with Africa (125, 51%) the most represented. Of those who attended both an in-person and virtual course, most (82%) preferred the in-person format. In addition, all measured course outcomes were significantly better for participants attending the in-person course. The most common reason for not attending an in-person course was the cost of travel (38, 51%). DISCUSSION This study demonstrated a preference toward in-person learning for the SMART course. In addition, those surgeons participating in the in-person course endorsed increased positive outcomes from the course. Increased emphasis should be placed on in-person surgical skills training for low-resource surgeons.
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Affiliation(s)
- Michael J. Flores
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Kelsey E. Brown
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Madeline C. MacKechnie
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Jamieson M. O’Marr
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Patricia Rodarte
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - David W. Shearer
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
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Dhillon J, Tanguilig G, Kraeutler MJ. Virtual and Augmented Reality Simulators Show Intraoperative, Surgical Training, and Athletic Training Applications: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00146-4. [PMID: 38387769 DOI: 10.1016/j.arthro.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To review published literature to identify and evaluate the effect of virtual reality (complete immersion) and augmented reality (overlay of digital information onto the physical world) simulators on intraoperative use for orthopaedic surgeons, orthopaedic surgical education, and athletic training. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies, published since 2014, that evaluated the role of augmented/virtual reality on intraoperative use for orthopaedic surgeons, orthopaedic surgical education, and athletic training. RESULTS Virtual reality (VR) simulators provide 3-dimensional graphical simulation of the physical world, and augmented reality (AR) simulators overlay digital information onto the physical world. Simulators can include interactive features (i.e., replication of intraoperative bleeding), haptic feedback, and unrestricted task repetition, and they can record, compare, and analyze performance while being easily accessible and eliminating the need for the presence of a mentor or coach. Four studies reported on VR for intraoperative use, 47 studies on surgical education, and 10 studies on athletic training. Two studies revealed the advantages of using VR simulation during intraoperative procedures, specifically showcasing its benefits for elbow arthroscopy, while 2 studies demonstrated similar positive outcomes for hip arthroscopy. Seventeen studies demonstrated that a VR simulator could be a beneficial tool to assist in surgical education for the knee, while 12 studies found that VR simulation is a valuable tool for aiding in surgical education of shoulder arthroscopy. Ten studies demonstrated that VR simulation improves skills in the operating room. Three studies revealed that individuals with more experience exhibit superior performance on these simulators compared to those with less experience. In the realm of athletic training, 10 studies showcased the potential of VR simulation to play a significant role in athletic performance and injury rehabilitation. CONCLUSIONS VR simulation shows benefits in the operating room, is a valuable tool for surgical education resulting in improved skills, and can be used to enhance athletic performance and injury rehabilitation. CLINICAL RELEVANCE Understanding that VR simulators can improve surgical outcomes, surgical skill training, and athletic training and rehabilitation could facilitate development and adoption of this advanced technology.
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Affiliation(s)
- Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, U.S.A
| | - Grace Tanguilig
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A..
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Youssef Y, De Wet D, Back DA, Scherer J. Digitalization in orthopaedics: a narrative review. Front Surg 2024; 10:1325423. [PMID: 38274350 PMCID: PMC10808497 DOI: 10.3389/fsurg.2023.1325423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Advances in technology and digital tools like the Internet of Things (IoT), artificial intelligence (AI), and sensors are shaping the field of orthopaedic surgery on all levels, from patient care to research and facilitation of logistic processes. Especially the COVID-19 pandemic, with the associated contact restrictions was an accelerator for the development and introduction of telemedical applications and digital alternatives to classical in-person patient care. Digital applications already used in orthopaedic surgery include telemedical support, online video consultations, monitoring of patients using wearables, smart devices, surgical navigation, robotic-assisted surgery, and applications of artificial intelligence in forms of medical image processing, three-dimensional (3D)-modelling, and simulations. In addition to that immersive technologies like virtual, augmented, and mixed reality are increasingly used in training but also rehabilitative and surgical settings. Digital advances can therefore increase the accessibility, efficiency and capabilities of orthopaedic services and facilitate more data-driven, personalized patient care, strengthening the self-responsibility of patients and supporting interdisciplinary healthcare providers to offer for the optimal care for their patients.
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Affiliation(s)
- Yasmin Youssef
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Deana De Wet
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
| | - David A. Back
- Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Julian Scherer
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
- Department of Traumatology, University Hospital of Zurich, Zurich, Switzerland
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Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JB JS Open Access 2024; 9:e23.00142. [PMID: 38511201 PMCID: PMC10950179 DOI: 10.2106/jbjs.oa.23.00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how trainees will engage and use these technologies longitudinally. Methods This was an exploratory, qualitative research study performed in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Orthopaedic surgery residents at a single institution were recruited during the 2022 to 2023 academic year. Semistructured interviews were conducted. Data were analyzed through grounded theory methodology, beginning with open coding, followed by axial coding, and concluding with selective coding that describes orthopaedic surgery residents' current perceptions of VR as a training tool. Results Six residents participated in interviews before thematic saturation was achieved. Average interview length was 13:27 (±2:59) minutes. Residents felt that currently, VR is most useful for interns and junior residents as an educational adjunct for learning anatomy, surgical exposures, and the steps of a procedure in a risk- and judgment-free arena. There seems to be a "ceiling effect" with VR given current technological limitations, and residents remarked that there is an associated "opportunity cost" with using VR technology. Some residents may find it more time-efficient to study texts, videos, or surgical guides rather than use VR. Cost (limited number of headsets) and technological barriers (i.e., hardware, software, and Wi-Fi issues) were some of the described barriers to VR utilization. Residents felt that there needs to be dedicated technological support to help with these issues. At this time, given these limitations of VR, many preferred VR as an optional educational adjunct rather than as a required curricular tool or assessment of surgical competency. Conclusions There is current utility for VR in orthopaedic surgical training. Future technological advances may make VR more central to resident education. This study describes resident perceptions about the technology and best use practices for the technology. Level of Evidence Qualitative Study, Level V Evidence.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Justin K. Yu
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine M. Gerull
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard M. Silverman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander W. Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Mavrodontis II, Trikoupis IG, Kontogeorgakos VA, Savvidou OD, Papagelopoulos PJ. Point-of-Care Orthopedic Oncology Device Development. Curr Oncol 2023; 31:211-228. [PMID: 38248099 PMCID: PMC10814108 DOI: 10.3390/curroncol31010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The triad of 3D design, 3D printing, and xReality technologies is explored and exploited to collaboratively realize patient-specific products in a timely manner with an emphasis on designs with meta-(bio)materials. METHODS A case study on pelvic reconstruction after oncological resection (osteosarcoma) was selected and conducted to evaluate the applicability and performance of an inter-epistemic workflow and the feasibility and potential of 3D technologies for modeling, optimizing, and materializing individualized orthopedic devices at the point of care (PoC). RESULTS Image-based diagnosis and treatment at the PoC can be readily deployed to develop orthopedic devices for pre-operative planning, training, intra-operative navigation, and bone substitution. CONCLUSIONS Inter-epistemic symbiosis between orthopedic surgeons and (bio)mechanical engineers at the PoC, fostered by appropriate quality management systems and end-to-end workflows under suitable scientifically amalgamated synergies, could maximize the potential benefits. However, increased awareness is recommended to explore and exploit the full potential of 3D technologies at the PoC to deliver medical devices with greater customization, innovation in design, cost-effectiveness, and high quality.
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Affiliation(s)
- Ioannis I. Mavrodontis
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.G.T.); (V.A.K.); (O.D.S.); (P.J.P.)
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Tronchot A, Casy T, Vallee N, Common H, Thomazeau H, Jannin P, Huaulmé A. Virtual reality simulation training improve diagnostic knee arthroscopy and meniscectomy skills: a prospective transfer validity study. J Exp Orthop 2023; 10:138. [PMID: 38095746 PMCID: PMC10721743 DOI: 10.1186/s40634-023-00688-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Limited data exist on the actual transfer of skills learned using a virtual reality (VR) simulator for arthroscopy training because studies mainly focused on VR performance improvement and not on transfer to real word (transfer validity). The purpose of this single-blinded, controlled trial was to objectively investigate transfer validity in the context of initial knee arthroscopy training. METHODS For this study, 36 junior resident orthopaedic surgeons (postgraduate year one and year two) without prior experience in arthroscopic surgery were enrolled to receive standard knee arthroscopy surgery training (NON-VR group) or standard training plus training on a hybrid virtual reality knee arthroscopy simulator (1 h/month) (VR group). At inclusion, all participants completed a questionnaire on their current arthroscopic technical skills. After 6 months of training, both groups performed three exercises that were evaluated independently by two blinded trainers: i) arthroscopic partial meniscectomy on a bench-top knee simulator; ii) supervised diagnostic knee arthroscopy on a cadaveric knee; and iii) supervised knee partial meniscectomy on a cadaveric knee. Training level was determined with the Arthroscopic Surgical Skill Evaluation Tool (ASSET) score. RESULTS Overall, performance (ASSET scores) was better in the VR group than NON-VR group (difference in the global scores: p < 0.001, in bench-top meniscectomy scores: p = 0.03, in diagnostic knee arthroscopy on a cadaveric knee scores: p = 0.04, and in partial meniscectomy on a cadaveric knee scores: p = 0.02). Subgroup analysis by postgraduate year showed that the year-one NON-VR subgroup performed worse than the other subgroups, regardless of the exercise. CONCLUSION This study showed the transferability of the technical skills acquired by novice residents on a hybrid virtual reality simulator to the bench-top and cadaveric models. Surgical skill acquired with a VR arthroscopy surgical simulator might safely improve arthroscopy competences in the operating room, also helping to standardise resident training and follow their progress. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Alexandre Tronchot
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France.
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tiphaine Casy
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
| | - Nicolas Vallee
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Harold Common
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Hervé Thomazeau
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Pierre Jannin
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
| | - Arnaud Huaulmé
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
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Testa EJ, Fadale PD. Arthroscopic Training: Historical Insights and Future Directions. J Am Acad Orthop Surg 2023; 31:1180-1188. [PMID: 37703548 DOI: 10.5435/jaaos-d-23-00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
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.
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Affiliation(s)
- Edward J Testa
- From the Department of Orthopaedic Surgery, Brown University, Warren Alpert Medical School, Providence, RI
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Guerra Bresson H, Baumann Q, El Koussaify J, Benayoun M, Maillot C, Rousseau MA, Boyer P. Arthroscopic approach in initial training: Study of a novice cohort using inverse direct and indirect approaches and its implication in the development of training programs. Orthop Traumatol Surg Res 2023; 109:103552. [PMID: 36649789 DOI: 10.1016/j.otsr.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 11/08/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Arthroscopic training includes successive stages of observation, reproduction and then repetition. Learning through simulation in 2D virtual reality makes it possible to repeat these different stages to enhance the learner's experience in complete safety and a shorter timeframe. Some procedures require inversion of the optical and instrumental approaches in the axial plane, disrupting the existing psychomotor and technical skills. The objective of this study was to compare the degree of difficulty and the distribution of results for the same exercise carried out alternately in classical holding and inverted holding of the instruments in a cohort of novice learners. MATERIALS AND METHODS Twenty-two medical students, novices in arthroscopic surgery, participated in the study. Each performed an exercise consisting of grasping ten targets with arthroscopic forceps and placing them in a basket on the VirtaMed ArthroS™ simulator. The exercise was performed with the scope and grasping instrument pointed away from the operator, "catch the stars front" (CTSF), then directed towards the operator, "catch the stars back" (CTSB). The simulator recorded several parameters making up an overall composite score ("overall performance score", OPS) out of 120 points. Voluntary abandonment of the exercise was also collected. RESULTS All students completed the CTSF exercise but 6 dropped out of the CTSB exercise (27%, p=0.01). In the CTSF exercise, the average OPS was higher with 45.9 points versus 22.8 points in the CTSB exercise (p<0.001). By detailing the components of the OPS score, the parameters of interest on the Fundamentals of Arthroscopic Training (FAST) module of the simulator included: the distance traveled by the scope and the grasping forceps was significantly greater in the CTSB group (p<0.001), the duration of the exercise was significantly greater in the CTSB group (p<0.001), the time spent with the instruments in the videoscopic field was significantly lower in the CTSB group (p=0.001) and finally the absence of a significant difference in the camera alignment compared to the horizontal plane between the two groups. CONCLUSION The exercise with the instruments directed towards the operator is more difficult with a greater distribution for all the secondary criteria except for the camera alignment, which suggests that it could be more discriminating. The dropout rate is also higher. It would therefore be interesting to introduce CTSB type training in initial training programs in arthroscopy. LEVEL OF EVIDENCE III, comparative prospective study.
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Affiliation(s)
- Héléna Guerra Bresson
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France.
| | - Quentin Baumann
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Jad El Koussaify
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Marie Benayoun
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Cédric Maillot
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Marc-Antoine Rousseau
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Patrick Boyer
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
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Reppenhagen S, Becker R, Kugler A, John D, Kopf S, Anetzberger H. Hand Dominance Is Not of Significance in Performing Fundamental Arthroscopic Skills Simulation Training Tasks. Arthrosc Sports Med Rehabil 2023; 5:100767. [PMID: 37636254 PMCID: PMC10448418 DOI: 10.1016/j.asmr.2023.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose To compare the performance of the dominant and nondominant hand during fundamental arthroscopic simulator training. Methods Surgical trainees who participated in a 2-day simulator training course between 2021 and 2023 were classified, according to their arthroscopic experience in beginners and competents. Only right-handed individuals with complete data sets were included in the study. Ambidexterity was trained using a box trainer (Fundamentals of Arthroscopic Surgery Training, Virtamed AG, Schlieren, Switzerland).Two tasks, periscoping for learning camera guidance and triangulation for additional instrument handling, were performed 4 times with the camera in the dominant hand and then in the nondominant hand. For each task, exercise time, camera path length, and instrument path length were recorded and analyzed. Results Out of 94 participants 74 right-handed individuals (22 females, 52 males) were classified to novices (n = 43, less than 10 independently performed arthroscopies) and competents (n = 31, more than 10 independently performed arthroscopies). Competents performed significantly better than novices. No significant difference was found after changing the guiding hand for the camera from the dominant to the nondominant hand regarding the camera path length and the instrument path length. Notably, tasks were performed even faster when using the camera in the nondominant hand. Conclusions Our data demonstrate that the learned manual skills during basic arthroscopic training are quickly transferred to the contralateral side. In consequence, additional fundamental skills training for camera guidance and instrument handling of the nondominant hand are not necessary. Clinical Relevance For skillful arthroscopy, camera guidance and instrument handing must be equally mastered with both hands. It is important to understand how hand dominance may affect learning during arthroscopic simulator training.
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Affiliation(s)
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Brandenburg der Medizinischen Hochschule Brandenburg Theodor Fontane, Brandenburg an der Havel, Germany
| | - Andreas Kugler
- Zentrum für Gelenkchirurgie im MVZ am Nordbad, München, Germany
| | | | - Sebastian Kopf
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Brandenburg der Medizinischen Hochschule Brandenburg Theodor Fontane, Brandenburg an der Havel, Germany
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Galuret S, Vallée N, Tronchot A, Thomazeau H, Jannin P, Huaulmé A. Gaze behavior is related to objective technical skills assessment during virtual reality simulator-based surgical training: a proof of concept. Int J Comput Assist Radiol Surg 2023; 18:1697-1705. [PMID: 37286642 DOI: 10.1007/s11548-023-02961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Simulation-based training allows surgical skills to be learned safely. Most virtual reality-based surgical simulators address technical skills without considering non-technical skills, such as gaze use. In this study, we investigated surgeons' visual behavior during virtual reality-based surgical training where visual guidance is provided. Our hypothesis was that the gaze distribution in the environment is correlated with the simulator's technical skills assessment. METHODS We recorded 25 surgical training sessions on an arthroscopic simulator. Trainees were equipped with a head-mounted eye-tracking device. A U-net was trained on two sessions to segment three simulator-specific areas of interest (AoI) and the background, to quantify gaze distribution. We tested whether the percentage of gazes in those areas was correlated with the simulator's scores. RESULTS The neural network was able to segment all AoI with a mean Intersection over Union superior to 94% for each area. The gaze percentage in the AoI differed among trainees. Despite several sources of data loss, we found significant correlations between gaze position and the simulator scores. For instance, trainees obtained better procedural scores when their gaze focused on the virtual assistance (Spearman correlation test, N = 7, r = 0.800, p = 0.031). CONCLUSION Our findings suggest that visual behavior should be quantified for assessing surgical expertise in simulation-based training environments, especially when visual guidance is provided. Ultimately visual behavior could be used to quantitatively assess surgeons' learning curve and expertise while training on VR simulators, in a way that complements existing metrics.
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Affiliation(s)
- Soline Galuret
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
| | - Nicolas Vallée
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Alexandre Tronchot
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Hervé Thomazeau
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Pierre Jannin
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France.
| | - Arnaud Huaulmé
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
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Thomas G, Long S, Kurtzhals T, Connor E, Anderson DD, Karam M, Kowalski H. A Dedicated Simulator Training Curriculum Improves Resident Performance in Surgical Management of Pediatric Supracondylar Humerus Fractures. JB JS Open Access 2023; 8:e23.00031. [PMID: 37701678 PMCID: PMC10489481 DOI: 10.2106/jbjs.oa.23.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background The primary goal of including simulation in residency training is to improve technical skills while working outside of the operating room. Such simulation-related skill improvements have seldom been measured in the operating room. This is largely because uncontrolled variables, such as injury severity, patient comorbidity, and anatomical variation, can bias evaluation of an operating surgeon's skill. In this study, performance during the wire navigation phase of pediatric supracondylar humerus fracture fixation was quantitatively compared between 2 groups of orthopaedic residents: a standard training group consisting of residents who participated in a single simulator session of wire navigation training and an expanded training group consisting of residents who participated in a dedicated multifaceted wire navigation simulation training curriculum. Methods To evaluate performance in the operating room, the full sequence of fluoroscopic images collected during wire navigation was quantitatively analyzed. Objective performance metrics included number of fluoroscopic images acquired, duration from placement of the first wire to that of the final wire, and wire spread at the level of the fracture. These metrics were measured from 97 pediatric supracondylar humerus fracture pinning surgeries performed by 28 different orthopaedic residents. Results No differences were observed between the groups for wire spread in the final fluoroscopic images (t(94) = 0.75, p = 0.45), an important clinical objective of the surgery. Residents who received the expanded simulator training used significantly fewer fluoroscopic images (mean of 46 vs. 61 images, t(85) = 2.25, p < 0.03) and required less time from first to final wire placement (mean of 11.2 vs. 14.9 minutes, t(83) = 2.53, p = 0.013) than the standard training group. A post hoc review of Accreditation Council for Graduate Medical Education case logs for 24 cases from the standard training group and for 21 cases from the expanded training group indicated that, at the time of surgeries, residents who received expanded training had completed fewer comparable cases than residents in the standard training group (mean of 13 vs. 21, t(42) = 2.40 p = 0.02). Further regression analysis indicated that the expanded simulator training produced an effect comparable with that associated with completing 10.5 similar surgical case experiences. Conclusions This study demonstrates that training on a wire navigation simulator can lead to improved performance in the operating room on a critical skill for all orthopaedic residents. By taking fewer images and less time while maintaining sufficient pin spread, simulator-trained residents were objectively measured to have improved performance in comparison with residents who had not participated in the pediatric elbow simulator curriculum. Clinical Relevance As programs aim to provide safe and effective training for critical orthopaedic skills such as pinning a pediatric elbow, this study demonstrates a simulator curriculum that has demonstrated the transfer of skill from a learning environment to the operating room.
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Affiliation(s)
- Geb Thomas
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Steven Long
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Trevor Kurtzhals
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Emily Connor
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa
| | - Matthew Karam
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Heather Kowalski
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
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Pettinelli NJ, Lee AY, Lee MS, Mahatme RJ, Gillinov SM, Jimenez AE. Virtual Reality Is an Effective Tool for Learning Techniques in Arthroplasty: A Systematic Review and Meta-Analysis. JAAOS: GLOBAL RESEARCH AND REVIEWS 2023; 7. [PMCID: PMC10284329 DOI: 10.5435/jaaosglobal-d-23-00078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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De Villeneuve Bargemon JB, Pangaud C, Levadoux M, Witters M, Merlini L, Viaud-Ambrosino S. What is the place of wrist arthroscopy in surgical residents' training? Wrist Arthroscopy in Residents Survey (WARS). Orthop Traumatol Surg Res 2022; 108:103429. [PMID: 36209986 DOI: 10.1016/j.otsr.2022.103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Wrist arthroscopy has become an essential method in the management of patients suffering from wrist pathologies. This technique must be mastered by residents wishing to specialize in upper limb surgery. However, no study has evaluated residents' access to wrist arthroscopy. HYPOTHESIS Residents have difficulty accessing wrist arthroscopy surgery during their training. MATERIALS AND METHODS We sent out an online questionnaire to all orthopedic and plastic surgery referents in France. Data were collected over a 6-month period from December 2020 to May 2021. A descriptive statistical analysis was performed. RESULTS Regarding the 98 responses obtained, we observed that 77.54% of residents have seen between 0 and 10 wrist arthroscopies and 35.71% have never seen a wrist arthroscopy. In addition, only 23.80% of residents have had access to training on cadavers, and 57.14% of residents were trained in private facilities. DISCUSSION Access to the operating room remains difficult for residents in upper limb surgery. Our results suggest that wrist arthroscopy training could be improved. New training methods could be adapted for wrist arthroscopy and to overcome the lack of access to wrist arthroscopy for residents. LEVEL OF INCIDENCE IV.
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Affiliation(s)
| | - Corentin Pangaud
- Orthopedic and Traumatology Surgery Department, Sainte-Marguerite Hospital, Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
| | - Marie Witters
- Hand surgery and Limb Reconstructive Surgery Department, Timone Adultes Hospital, Marseille, France
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Procedural simulation training in orthopaedics and traumatology: Nationwide survey among surgeon educators and residents in France. Orthop Traumatol Surg Res 2022; 108:103347. [PMID: 35688379 DOI: 10.1016/j.otsr.2022.103347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France. HYPOTHESIS Nationwide, SBT is not used to its full capacity for teaching OTS in France, and differences in opinions about SBT may exist between surgeon educators and residents. STUDY DESIGN Nationwide questionnaire survey in France. MATERIALS AND METHODS We built two specific self-questionnaires then e-mailed them between December 2020 and February 2021 to the surgeon educators who were members of the national university council and to the residents specialising in OTS during the current academic year. The questions were about the 2018-2019 academic year, before the COVID-19 pandemic. Two classes of residents who were still medical students during this period were not included, leaving three classes for the analysis. RESULTS The participation rates were 57% (67/117) for the educators and 24% (87/369) for the three classes of residents. Of the 67 educators, 47 (70%) reported being involved in SBT and identified the university (70%) and industry (53%) as the main funders of this teaching modality. The educators indicated that the mean number of SBT laboratories in their region was 1.4±0.9 (range, 0-4). The main types of simulators were saw bones (77%); cadavers (85%); and commercial simulators (74%), notably for the knee (87%) and shoulder (78%). The educators estimated that they had achieved a mean of 33%±23% (range, 0%-100%) of the teaching objectives set out in the OTS curriculum and that the main obstacles were insufficient funding (81%) and lack of time (67%). Only 21% of educators reported conducting SBT research. The residents reported that they accessed SBT via the OTS teaching module (28/87, 32%), local university degrees (23/87, 26%), their hospital department (17/87, 18%), or the industry (15/87, 17%); 25/87 (29%) had never received SBT. On a 0-10 scale (0, completely disagrees; 10, completely agrees), the mean score for SBT effectiveness was 8.6±2.1 for residents and 7.1±3.0 for educators (p<0.001); the corresponding values for the quality of SBT integration in the region were 1.5±1.8 and 3.8±2.6, respectively (p<0.001). CONCLUSION SBT is not yet used to its full potential for teaching OTS in France. Insufficient funding and lack of time were identified by the educators as the main obstacles to greater use of SBT. Both the residents and the educators felt that SBT mightbe beneficial for training. LEVEL OF EVIDENCE IV, nationwide survey.
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Su Z, Liu Y, Zhao W, Bai Y, Jiang N, Zhu S. Digital technology for orthognathic surgery training promotion: a randomized comparative study. PeerJ 2022; 10:e13810. [PMID: 35935255 PMCID: PMC9354792 DOI: 10.7717/peerj.13810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background This study aims to investigate whether a systematic digital training system can improve the learning efficiency of residents in the first-year orthognathic surgery training course and evaluate its effectiveness in teaching orthognathic surgery. Methods A digital training system was applied, and a comparative research approach was adopted. 24 first-year orthognathic surgery residents participated in the experiment as part of their professional skill training. The Experimental group was required to use a digital training system, and the Control group was trained in lectures without digital technologies. Three indicators, including theoretical knowledge and clinical operation, were assessed in tests, and evaluations from instructors were analyzed to evaluate learning efficiency. Results The results showed that the scores in theoretical tests, practical operations, and teacher evaluations, the Experimental groups were all higher than the Control group (P = 0.002 for anatomy, P = 0.000 for operation theory) after using digital technology, except for the understanding of complications (P = 0.771). In addition, the questionnaire survey results showed that the study interest (P = 0.001), self-confidence (P = 0.001), satisfaction (P = 0.002), and academic performance (P = 0.001) of the residents of the Experimental group were higher than those of the Control group. Conclusions The outcomes indicated that the digital training system could benefit orthognathic residents' learning efficiency, and learning interest and teaching satisfaction will also improve.
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Affiliation(s)
- Zhan Su
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yao Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenli Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuanyan Bai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score. Knee Surg Sports Traumatol Arthrosc 2022; 30:1471-1479. [PMID: 34189609 DOI: 10.1007/s00167-021-06648-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Simulator arthroscopy training has gained popularity in recent years. However, it remains unclear what level of competency surgeons may achieve in what time frame using virtual training. It was hypothesized that 10 h of training would be sufficient to reach the target level defined by experts based on the Diagnostic Arthroscopic Skill Score (DASS). METHODS The training concept was developed by ten instructors affiliated with the German-speaking Society of Arthroscopy and Joint Surgery (AGA). The programme teaches the basics of performing arthroscopy; the main focus is on learning and practicing manual skills using a simulator. The training was based on a structured programme of exercises designed to help users reach defined learning goals. Initially, camera posture, horizon adjustment and control of the direction of view were taught in a virtual room. Based on these skills, further training was performed with a knee model. The learning progress was assessed by quantifying the exercise time, camera path length and instrument path length for selected tasks. At the end of the course, the learners' performance in diagnostic arthroscopy was evaluated using DASS. Participants were classified as novice or competent based on the number of arthroscopies performed prior to the assessment. RESULTS Except for one surgeon, 131 orthopaedic residents and surgeons (29 women, 102 men) who participated in the seven courses agreed to anonymous data analysis. Fifty-eight of them were competents with more than ten independently performed arthroscopies, and 73 were novices, with fewer than ten independently performed arthroscopies. There were significant reductions in exercise time, camera path length and instrument path length for all participants after the training, indicating a rapid increase in performance. No difference in camera handling between the dominant and non-dominant sides was found in either group. The competents performed better than the novices in various tasks and achieved significantly better DASS values on the final performance test. CONCLUSIONS Our data have demonstrated that arthroscopic skills can be taught effectively on a simulator, but a 10-h course is not sufficient to reach the target level set by experienced arthroscopists. However, learning progress can be monitored more objectively during simulator training than in the operating room, and simulation may partially replace the current practice of arthroscopic training. LEVEL OF EVIDENCE III.
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Surgical simulation training should become a mandatory part of orthopaedic education. J Exp Orthop 2022; 9:22. [PMID: 35229207 PMCID: PMC8884100 DOI: 10.1186/s40634-022-00455-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Ethical concerns and increasing economic constraints of hospitals have caused a reduction in proper training and education. It has been hypothesized that due to the lack of a one-to-one apprenticeship throughout the residency, surgical simulation training is essential. Methods Between June 2020 and June 2021, residents from teaching hospitals in Switzerland, France, Germany, and Luxembourg were surveyed to learn about their experience with and thoughts on surgical simulation training. Survey responses were analysed using descriptive statistics. Results Of the 596 residents surveyed, 557 residents (51% female, 49% male) from Switzerland (270), France (214), Germany (52) and Luxembourg (21) agreed to anonymous data analysis. Among those giving consent, 100% considered that simulation training was important for their practical education and 84% thought that simulation training should become a mandatory part of their curriculum, with an average estimated training time of 42 ± 51 h per year, based on the survey. Conclusions This study suggests that surgical simulation training is well accepted and even demanded among surgical residents as an alternative training solution able to address some of the limitations and challenges of the current one-to-one apprenticeship model. There is a wide variation among the residents regarding the number of training hours required, underscoring the need for structured performance-based simulator training.
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22
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Anetzberger H, Becker R, Eickhoff H, Seibert FJ, Döring B, Haasters F, Mohr M, Reppenhagen S. The Diagnostic Arthroscopy Skill Score (DASS): a reliable and suitable assessment tool for arthroscopic skill training. Knee Surg Sports Traumatol Arthrosc 2022; 30:349-360. [PMID: 33914120 DOI: 10.1007/s00167-021-06554-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To develop and validate a novel score to more objectively assess the performance of diagnostic knee arthroscopy using a simulator. METHODS A Diagnostic Arthroscopy Skill Score (DASS) was developed by ten AGA (AGA-Society for Arthroscopy and Joint-Surgery) instructors for the assessment of arthroscopic skills. DASS consists of two parts: the evaluation of standardized diagnostic knee arthroscopy (DASSpart1) and the evaluation of manual dexterity, including ambidexterity and triangulation, using objective measurement parameters (DASSpart2). Content validity was determined by the Delphi method. One hundred and eleven videos of diagnostic knee arthroscopies were recorded during simulator training courses and evaluated by six specially trained instructors using DASS. Construct validity, measurement error calculated by the minimum detectable change (MDC), internal consistency using Cronbach's alpha and interrater and intrarater reliability were assessed. The Bland-Altman method was used to calculate the intrarater agreement. RESULTS Six skill domains were identified and evaluated for each knee compartment. DASS, DASSpart1, and DASSpart2 showed construct validity, with experts achieving significantly higher scores than competents and novices. MDC was 4.5 ± 1.7 points for DASSpart1. There was high internal consistency for all domains in each compartment from 0.78 to 0.86. The interrater reliability showed high agreement between the six raters (ICC = 0.94). The evaluation of intrarater reliability demonstrated good and excellent agreement for five raters (ICC > 0.80) and moderate agreement for one rater (ICC = 0.68). The Bland-Altman comparison showed no difference between the first and second evaluations in five out of six raters. Precision, estimated by the regression analysis and comparison with the method of Bland and Altman, was excellent for four raters and moderate for two raters. CONCLUSIONS The results of this study indicate good validity and reliability of DASS for the assessment of the surgical performance of diagnostic knee arthroscopy during simulator training. Standardized training is recommended before arthroscopy surgery is considered in patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hermann Anetzberger
- Orthopädische Gemeinschaftspraxis am OEZ, Hanauer Str. 65, 80993, Munich, Germany.
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Medizinische Hochschule Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - Hansjörg Eickhoff
- Orthopädie und Unfallchirurgie, Abteilung Arthroskopie u. Schulterchirurgie, GFO-Kliniken Troisdorf, Hospitalstr. 45, 53840, Troisdorf, Germany
| | - Franz Josef Seibert
- Medizinische Universität Graz, Universitätsklinik für Orthopädie und Traumatologie LKH-Uniklinikum, Auenbruggerplatz 7a, 8010, Graz, Austria
| | - Bernd Döring
- Zentrum für Orthopädie und Unfallchirurgie, Medizinische Hochschule Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Florian Haasters
- Schönklinik München Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - Michael Mohr
- Orthopädisches Zentrum Bad Säckingen, Rudolf-Eberle-Platz 3, 79713, Bad Säckingen, Germany
| | - Stephan Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany
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23
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Tronchot A, Berthelemy J, Thomazeau H, Huaulmé A, Walbron P, Sirveaux F, Jannin P. Validation of virtual reality arthroscopy simulator relevance in characterising experienced surgeons. Orthop Traumatol Surg Res 2021; 107:103079. [PMID: 34597826 DOI: 10.1016/j.otsr.2021.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Virtual reality (VR) simulation is particularly suitable for learning arthroscopy skills. Despite significant research, one drawback often outlined is the difficulty in distinguishing performance levels (Construct Validity) in experienced surgeons. Therefore, it seems adequate to search new methods of performance measurements using probe trajectories instead of commonly used metrics. HYPOTHESIS It was hypothesized that a larger experience in surgical shoulder arthroscopy would be correlated with better performance on a VR shoulder arthroscopy simulator and that experienced operators would share similar probe trajectories. MATERIALS & METHODS After answering to standardized questionnaires, 104 trajectories from 52 surgeons divided into 2 cohorts (26 intermediates and 26 experts) were recorded on a shoulder arthroscopy simulator. The procedure analysed was the "loose body removal" in a right shoulder joint. 10 metrics were computed on the trajectories including procedure duration, overall path length, economy of motion and smoothness. Additionally, Dynamic Time Warping (DTW) was computed on the trajectories for unsupervised hierarchical clustering of the surgeons. RESULTS Experts were significantly faster (Median 70.9s Interquartile range [56.4-86.3] vs. 116.1s [82.8-154.2], p<0.01), more fluid (4.6.105mm.s-3 [3.1.105-7.2.105] vs. 1.5.106mm.s-3 [2.6.106-3.5.106], p=0.05), and economical in their motion (19.3mm2 [9.1-25.9] vs. 33.8mm2 [14.8-50.5], p<0.01), but there was no significant difference in performance for path length (671.4mm [503.8-846.1] vs 694.6mm [467.0-1090.1], p=0.62). The DTW clustering differentiates two expertise related groups of trajectories with performance similarities, respectively including 48 expert trajectories for the first group and 52 intermediates and 4 expert trajectories for the second group (Sensitivity of 92%, Specificity of 100%). Hierarchical clustering with DTW significantly identified expert operators from intermediate operators and found trajectory similarities among 24/26 experts. CONCLUSION This study demonstrated the Construct Validity of the VR shoulder arthroscopy simulator within groups of experienced surgeons. With new types of metrics simply based on the simulator's raw trajectories, it was possible to significantly distinguish levels of expertise. We demonstrated that clustering analysis with Dynamic Time Warping was able to reliably discriminate between expert operators and intermediate operators. CLINICAL RELEVANCE The results have implications for the future of arthroscopic surgical training or post-graduate accreditation programs using virtual reality simulation. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Alexandre Tronchot
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | | | - Hervé Thomazeau
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Arnaud Huaulmé
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Paul Walbron
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - François Sirveaux
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - Pierre Jannin
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
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Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual Reality in Orthopedic Surgery Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1295-1301. [PMID: 34785971 PMCID: PMC8590940 DOI: 10.2147/amep.s321885] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2021] [Indexed: 06/09/2023]
Abstract
One emerging technology with the potential to improve and further transform the field of orthopaedic surgery is virtual reality (VR). VR has been explored and used in many different specialties with clinical applications, such as psychiatric therapy, pain management, rehabilitation, and traumatic brain injury. Recent studies have suggested that the use of VR during the training of orthopaedic surgery residents produces similar or improved surgical performance by residents. This is an area where VR can provide a tremendous benefit to the field of orthopaedic surgery, as it offers a safe and accessible complement to orthopaedic surgical training outside of the operating room (OR) and without involving patients directly. This review will elucidate the current state of virtual reality use in the training of orthopaedic surgeons and highlight key benefits and challenges in its application as a training resource.
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Affiliation(s)
- Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Baumann Q, Bulaid Y, Van Vliet A, Gabrion A, Klein C, Mertl P. Sleep Deprivation Adversely Impacts Resident Performance for Simulated Arthroscopy. Arthrosc Sports Med Rehabil 2021; 3:e1125-e1132. [PMID: 34430893 PMCID: PMC8365208 DOI: 10.1016/j.asmr.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to assess the performance of residents in orthopaedics before and after a 24-hour shift on a shoulder arthroscopy simulator. The primary study endpoint was an overall performance score (OPS) generated by the simulator. Methods A prospective, comparative study of 120 simulator trials by 10 resident junior surgeons was performed in our university hospital’s simulation center between May and November 2018. To avoid memorization bias, all participants performed the same exercise 10 times on a VirtaMed ArthroS simulator prior to the study. Each resident’s performance (the OPS, the operating time, the proportion of procedures with iatrogenic lesions, the camera path length and the hook path length) in two different simulated arthroscopy exercise tasks was assessed once before and once after a 24-hour shift. This sequence was performed three times during the semester, and the change over time in performance was also evaluated. Results The OPS was significantly lower after the night shift (P = 0.035 for the first exercise, and P = 0.025 for the second). Conclusion In a group of previously trained resident junior surgeons, overall performance with an arthroscopy simulator was significantly worse after a 24-hour shift. The study of secondary parameters of the OPS and the subgroup analysis based on the sleep time and Epworth score vary depending on the type of exercise performed arthroscopically. However, the use of a simulator after a night shift did not prevent the trainee from improving his/her level of performance over time. Level of Evidence II, a prospective, comparative study
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Affiliation(s)
- Quentin Baumann
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens cedex 1, France
- Address correspondence to Quentin Baumann, M.D., Department of Orthopedic and Trauma Surgery, Amiens University Medical Center and Jules Verne University of Picardie, F-80054 Amiens cedex 1, France.
| | - Yassine Bulaid
- Department of Pediatric Orthopedic Surgery. Amiens University Medical Center and Jules Verne University of Picardie, Amiens cedex 1, France
| | - Axel Van Vliet
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens cedex 1, France
| | - Antoine Gabrion
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens cedex 1, France
| | - Céline Klein
- Orthopedic and Sports Surgery Center, Cap Ortho, Clinique Anne d’Artois, Bethune, France
| | - Patrice Mertl
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens cedex 1, France
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Shetty V, Wagh Y, Karade V, Maurya A, Parihar M, Shekhar S, Tandel J. CT-Based 3D Reconstruction of Lower Limb Versus X-Ray-Based 3D Reconstruction: A Comparative Analysis and Application for a Safe and Cost-Effective Modality in TKA. Indian J Orthop 2021; 55:1150-1157. [PMID: 34824715 PMCID: PMC8586399 DOI: 10.1007/s43465-021-00456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
AIM Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D®) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D® versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia). METHOD In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle-MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D® and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided t tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D®, were also measured. RESULTS For all the 11 parameters, no statistically significant difference was found between the 2 groups (p > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D® and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits. CONCLUSION The reconstruction accuracy of the XrayTo3D® is an accurate, safe and cost effective as compared to a CT-based method.
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Affiliation(s)
- Vivek Shetty
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Yash Wagh
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Vikas Karade
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Amit Maurya
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Mangal Parihar
- Department of Orthopedics, Mangal Anand Hospital, 48, Swastik Park Building, Sion Trombay Road, Chembur East, Mumbai, Maharashtra 400071 India
| | - Sajeev Shekhar
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Jignesh Tandel
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
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Kohan L, Durbhakula S, Zaidi M, Phillips CR, Rowan CC, Brenner GJ, Cohen SP. Changes in Pain Medicine Training Programs Associated With COVID-19: Survey Results. Anesth Analg 2021; 132:605-615. [PMID: 33177326 DOI: 10.1213/ane.0000000000005314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted. METHODS A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The initial survey was hosted by Qualtrics Inc and disseminated by the Association of Pain Program Directors on April 10, 2020, to program directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data. RESULTS Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just more than half of programs had either already deployed (14%) or credentialed (39%) fellows to provide nonpain care. Higher state infection rates were significantly associated with reduced clinical demand (Rs = 0.31, 95% confidence interval [CI], 0.08-0.51; P = .011) and redeployment of fellows to nonpain areas (Rs = 0.30, 95% CI, 0.07-0.50; P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees. CONCLUSIONS We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.
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Affiliation(s)
- Lynn Kohan
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Cody C Rowan
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Gary J Brenner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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28
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Der Arthroskopie-Simulator als fester Bestandteil der Weiterbildung in der Orthopädie und Unfallchirurgie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Anetzberger H, Mohr M, Eickhoff H, Seibert FJ, Döring B, Reppenhagen S. Drei Jahre AGA Simulatortraining Arthroskopie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-020-00428-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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