The learning curves of a validated virtual reality hip arthroscopy simulator

Abstract

Introduction Decreases in trainees’ working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate an additional means of training. Though virtual reality simulation has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training—with practice reflecting increases in validated performance metrics. Methods Twenty-five medical students with no previous experience of hip arthroscopy completed seven weekly simulated arthroscopies of a healthy virtual hip joint using a 70° arthroscope in the supine position. Twelve targets were visualised within the central compartment, six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. Task duration, number of collisions (bone and soft-tissue), and distance travelled by arthroscope were measured by the simulator for every session of each student. Results Learning curves were demonstrated by the students, with improvements in time taken, number of collisions (bone and soft-tissue), collision length and efficiency of movement (all p < 0.01). Improvements in time taken, efficiency of movement and number of collisions with soft-tissue were first seen in session 3 and improvements in all other parameters were seen in session 4. No differences were found after session 5 for time taken and length of soft-tissue collision. No differences in number of collisions (bone and soft-tissue), length of collisions with bone, and efficiency of movement were found after session 6. Conclusions The results of this study demonstrate learning curves for a hip arthroscopy simulator, with significant improvements seen after three sessions. All performance metrics were found to improved, demonstrating sufficient visuo-haptic consistency within the virtual environment, enabling individuals to develop basic arthroscopic skills.

The role of an Orthopaedic Surgeon in the time of Covid-19 Pandemic–a German perspective

“…In some fields of surgery, i.e. arthroscopy, parts of manual training can be done using simulators and while some years back most of these simulators had been plastic models, nowadays they have become more and more virtual 7,8 . That allows for a separation of teacher and student, which is mandatory in times of Coronavirus or other possible pandemics.…”

Recent advances and future trends in hip arthroscopy

“…[35] While earlier evidence advocated the use of box simulators in surgical simulation, there have been limited reports of learning curves for novice surgeons using VR simulators within the field of HA. [36] This has in part been due to a low number of validated VR simulation models. Recently, however, learning curves have been reported for a validated VR trainer [Simbionix Arthro Mentor - Figure 2].…”

“…Recently, however, learning curves have been reported for a validated VR trainer [Simbionix Arthro Mentor - Figure 2]. [36] Significant training effects were demonstrated after three sessions as participants' rate of collision between the arthroscope and soft tissues [ Figure 3], as well as femoral head, is significantly reduced. All training effect measures improved over the course of seven sessions, demonstrating that VR HA simulators provide sufficient visual and haptic feedback improving dexterity and shortening the learning curve.…”

History of hip arthroscopy

“…This has demonstrated a significant improvement in surgeon performance after three sessions. [55] New technologies in theater prove challenging for surgeons. This is especially true for minimally invasive surgery (MIS) where there is a more demanding work environment and there are less rigorous safety and testing standards for instruments compared to similar medical industries such as pharmaceuticals.…”