Force measurement metrics for simulated elbow arthroscopy training

Abstract

BackgroundElbow arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in elbow arthroscopy. Force exerted on the elbow tissue during arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic elbow navigation in cadaveric specimens and assess their applicability in elbow arthroscopy training.MethodsTwo cadaveric elbows were mounted on a Force Measurement Table (FMT) that allowed 3-dimensional measurements (x-, y-, and z-plane) of the forces exerted on the elbow. Five experts in elbow arthroscopy performed arthroscopic navigation once in each of two cadaveric elbows, navigating through the posterior, posterolateral and anterior compartment in a standardized fashion with visualization of three to four anatomic landmarks per compartment. The total absolute force (Fabs) and force direction exerted (α and β) on the elbow during arthroscopy were recorded. α being the angle in the horizontal plane and β being the angle in the vertical plane. The 10th–90th percentiles of the data were used to set threshold levels for training.ResultsThe median Fabs was 24 N (19 N – 30 N), 27 N (20 N – 33 N) and 29 N (23 N – 32 N) for the posterior, posterolateral and anterior compartment, respectively. The median α was - 29° (- 55° – 5°), - 23° (- 56° – -1°) and 4° (- 22° – -18°) for the posterior, posterolateral and anterior compartment, respectively. The median β was - 71° (- 80° – -65°), - 76° (- 86° – -69°) and - 75° (- 81° – -71°) for the posterior, posterolateral and anterior compartment, respectively.ConclusionExpert data on force magnitude and force direction exerted on the elbow during arthroscopic navigation in cadaveric specimens were collected. The proposed maximum allowable force of 30 N (smallest 90th percentile of Fabs) exerted on the elbow tissue, and the 10th–90th percentile range of the force directions (α and β) for each compartment may be used to provide objective feedback during arthroscopic skills training.

An In-Office Hysteroscopy VR/Haptic Simulation Platform for Training in Spatial Navigation and Passage of the Cervical Canal

“…3) Force-based metrics: maximal force f max and force fast Fourier transform (FFT) f F F T (integral value of force amplitude in the frequency domain in the range between 1 and 13 Hz corresponding to the frequency range of voluntary motion and physiological tremor). While the maximal force performance metric was presented in previous studies [43], the authors were not able to find any mention of f F F T in the literature. We assume that the value corresponds to the magnitude of oscillation of both voluntary and involuntary movements, and, as such, can be representative of the overall confidence level in a subject.…”

Understanding the role of nontechnical skills in minimally invasive surgery and their integration in technology enhanced learning environments

“…-VR is the most used technology for training surgical skills, and also the most versatile (i.e., it can be used for the training of both technical and nontechnical skills) [93,98,99,[150][151][152]163,172,177,196,222,227,228]. -Live interventions [190,192,[205][206][207]221,224] and box trainers [87,173,178,187,190,[229][230][231] are the second and third most popular TELbased training methodologies. However, the effectiveness of box trainers has been mostly proven for psychomotor skills' training (and personal resourcefulness to a lesser degree) while live interventions have proven effective for more nontechnical skills.…”