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A Novel Approach to Teaching Visual-spatial Skills in Wire Navigated Procedures
Jenniefer Y. Kho, M.D.J. L. Marsh, MD, Geb Thomas, PhD, Brian
Johns, MS, Don Anderson, PhDUniversity of Iowa Hospitals and Clinics
Aided by a Grant from the Orthopaedic Research and Education Foundation
Introduction
Surgical simulation in orthopaedic trauma is lacking
Benchtop models
Leong et al. Validation of orthopaedic bench models for trauma surgery. JBJSBr 2008. Atesok. Surgcial Simulation in Orthopaedic
Skills Training. JAAOS 2012;20:410-422.
Yehyawi et al. A simulation trainer for complex articular fracture surgery. JBJS 2013.
Blyth. A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 2007.
Virtual Reality Simulator
Froelich et al. Surgical Simulators and Hip Fracture: A Role in Residency Training? Journal of Surgical Education 2011.
Haptic-based simulator
Background
Wire navigation, or the ability to target a wire to a precise location through an osseous trajectory, is a fundamental skill in orthopaedic surgery.
Aims
• Develop a radiation-free electromagnetic sensor-based wire navigation simulator in a proximal femur model
• Determine if simulator training improves performance in novice (PGY-1) surgeons
• Compare novice and expert (senior residents/staff) surgeons
TrakStar simulator development
Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
- Tip-apex-distance- Time- # fluoro shots- # of attempts
Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
MethodsTAD 20.9mm – 53 images
TAD 17.8mm – 50 images
TAD 12.05mm – 42 images
Trial 1
Trial 2
Trial 3
Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
- Tip-apex-distance- Time- # fluoro shots- # of attempts
Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
PGY-4/Staff
- Tip-apex-distance- Time- # fluoro shots- # of attempts
Results
Pre-test* Post-test* p-value
Tip-apex distance, mm (TAD) 19.46+2.15 25.02+8.79 0.23
Number of fluoroscopy shots 36.85+13.73 27+9.27 0.045
Number of attempts 5.83+4.16 2.16+1.83 0.08
Time (mins) 8:00 5:11 0.012
* Mean+SD
Table 1. Pre vs posttest (PGY-1)
Results
Novice* Expert* p-value
Tip-apex distance, mm (TAD) 21.46+7.11 12.69+3.9 0.006
Number of fluoroscopy shots 33+13.78 29.6+12.30 0.62
Time (min) 3:16 2:32 0.17
Table 2. Novice vs expert surgeons
* Mean+SD
Trial 1 Trial 2 Trial 30
5
10
15
20
25
PGY-1PGY-4Staff
TAD
(mm
)
Results of simulator practice in all groups
Trial 1 Trial 2 Trial 30
10
20
30
40
50
PGY-1PGY-4Staff
# flu
oro
shot
s
Trial 1 Trial 2 Trial 30:000:280:571:261:552:242:523:213:504:19
Tim
e (m
in)
Results of simulator practice in all groups
Discussion
• TrakStar wire navigation simulator can distinguish novice and expert surgeons– Increased TAD in novice surgeons
• Practice on the simulator leads to decreased time and fluoroscopic shots, but no difference in TAD (actually increased)
Discussion
• Simulator needs to be affordable, user-friendly, demonstrate validity– Trakstar is expensive– Need further validation studies
• Currently testing the simulator in graduate students and more senior surgeons