Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy

Abstract

PURPOSE The aim of this work is to determine face validity and construct validity of a new virtual-reality-based simulator for diagnostic and therapeutic knee arthroscopy. METHODS The study tests a novel arthroscopic simulator based on passive haptics. Sixty-eight participants were grouped into novices, intermediates, and experts. All participants completed two exercises. In order to establish face validity, all participants filled out a questionnaire concerning different aspects of simulator realism, training capacity, and different statements using a seven-point Likert scale (range 1-7). Construct validity was tested by comparing various simulator metric values between novices and experts. RESULTS Face validity could be established: overall realism was rated with a mean value of 5.5 points. Global training capacity scored a mean value of 5.9. Participants considered the simulator as useful for procedural training of diagnostic and therapeutic arthroscopy. In the foreign body removal exercise, experts were overall significantly faster in the whole procedure (6 min 24 s vs. 8 min 24 s, p < 0.001), took less time to complete the diagnostic tour (2 min 49 s vs. 3 min 32 s, p = 0.027), and had a shorter camera path length (186 vs. 246 cm, p = 0.006). CONCLUSION The simulator achieved high scores in terms of realism. It was regarded as a useful training tool, which is also capable of differentiating between varying levels of arthroscopic experience. Nevertheless, further improvements of the simulator especially in the field of therapeutic arthroscopy are desirable. In general, the findings support that virtual-realitybased simulation using passive haptics has the potential to complement conventional training of knee arthroscopy skills. LEVEL OF EVIDENCE: II. Abstract Purpose The aim of this work is to determine face validity and construct validity of a new virtual-reality-based simulator for diagnostic and therapeutic knee arthroscopy. Methods The study tests a novel arthroscopic simulator based on passive haptics. Sixty-eight participants were grouped into novices, intermediates, and experts. All participants completed two exercises. In order to establish face validity, all participants filled out a questionnaire concerning different aspects of simulator realism, training capacity, and different statements using a seven-point Likert scale (range 1-7). Construct validity was tested by comparing various simulator metric values between novices and experts. Results Face validity could be established: overall realism was rated with a mean value of 5.5 points. Global training capacity scored a mean value of 5.9. Participants considered the simulator as useful for procedural training of diagnostic and therapeutic arthroscopy. In the foreign body removal exercise, experts were overall significantly faster in the whole procedure (6 min 24 s vs. 8 min 24 s, p \ 0.001), took less time to complete the diagnostic tour (2 min 49 s vs. 3 min 32 s, p = 0.027), and had a shorter camera path length (186 vs. 246 cm, p = 0.0...

Testing Basic Competency in Knee Arthroscopy Using a Virtual Reality Simulator

“…Furthermore, all of the participating experienced surgeons thought that procedure 5 did not resemble a realistic meniscus resection by any means, thus also lacking content validity 15 , and for these reasons, the procedure was excluded from the test. Other literature has also found that the current commercially available virtual reality arthroscopy simulators are somewhat deficient with regard to therapeutic procedures 3,4, 16 .…”

“…It is also important to notice that the simulator only allows us to assess certain technical skills important to diagnostic knee arthroscopy. Other essential technical skills such as the optimal placement of portals 16 and nontechnical skills such as the ability to set correct indications for surgery are not assessed. Furthermore, locating and palpating blue spheres at defined landmarks is a rather simplified surrogate target for a diagnostic arthroscopy.…”

“…Several studies have described virtual reality arthroscopy simulators and have explored the construct validity of the simulator metrics 5,7,13,16,22,23 . Many of these studies have explored virtual reality shoulder arthroscopy simulators 7,13,22,23 , but we decided to focus only on diagnostic knee arthroscopy, as this is often the first arthroscopic procedure that residents are required to perform.…”

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

“…Multiple studies have demonstrated the construct validity of simulators by showing a correlation between a surgeon's experience and their performance on a simulator. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The procedures where this has been reported include diagnostic and therapeutic knee, hip and shoulder arthroscopy, hip fracture fixation, the fixation of complex intra-articular fractures and basic orthopaedic skills, including drilling (Table II). Studies assessing learning curves.…”

Model of realism score for immersive VR systems

“…Realism-wise, the quantifying mostly comes with a question about the realistic-ness of the experimentation a subject just gone through (which is to be tied to the fourth acceptation, ''psychological realism"). A more detailed approach goes through questionnaires (Fucentese et al, 2015;Gaelle et al, 2014). There are though different other approaches that are to be highlighted:…”