Surgical skills simulation in trauma and orthopaedic training

Stirling, Euan; Lewis, Thomas; Ferran, Nicholas Antonio

doi:10.1186/s13018-014-0126-z

Cited by 99 publications

(70 citation statements)

References 42 publications

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“…Although cadaveric training provides the most realistic experience, cadaveric training is not the preferred method to start training elbow arthroscopy skills. First, because cadaveric training is expensive and there is limited availability (Camp et al, 2016 ; Stirling et al, 2014 ). Moreover, as was also shown in this study, the anatomic variation amongst cadaveric specimen as well as their joint status in due to time compromises similar training conditions for a certain amount of repetitions or trainees.…”

Section: Discussionmentioning

confidence: 99%

Force measurement metrics for simulated elbow arthroscopy training

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

Force measurement metrics for simulated elbow arthroscopy training

et al. 2018

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“…Relatively few of these simulators have been assimilated into the surgical training curriculum. 5 Many of these models are expensive to produce, difficult to replicate, and animal/cadaveric models may carry a risk of zoonotic disease transmission or hepatitis.…”

Section: Introductionmentioning

confidence: 99%

Tendon repair simulation: a comparison of training models

Musbahi¹,

Henton²

2019

J Surg Simul

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Introduction: Surgical training has undergone many changes in the last few decades from the apprenticeship model of the past and a focus currently on shift patterns and working time directives. These have placed greater stresses on the current surgical trainees to obtain training opportunities, thus increasing the role for simulation activities and models. There is a need for reproducible, low cost and realistic training models for all surgical subspecialties. These allow the training exercise to be undertaken at any time, with supervision, and in a safe environment without compromise to patient care. As a training model for tendon repair, we created a simulated tendon that we believe is an excellent alternative to cadaveric, porcine or other materials such as liquorice. Methods: Experienced trainees and consultants with exposure and experience in performing human tendon repair were asked to perform a simulated repair on each of three models: silicone bathroom sealant, porcine tendon and liquorice. Each model tendon was secured to a wooden board and cut at its midpoint. The models were 5 mm in diameter and between 5 and 10 cm long. Participants performed a modified Kessler repair using standard surgical instruments and a 3-0 monofilament suture, and rated each model using a five-point Likert scale to assess suture gliding, likeness to human tendon, tendon handling and usefulness for training. Results: The porcine tendon was considered the most realistic (90.5%); however, the silicone model was a close second (86.5%). Silicone compared well for handling (4.4/5) and was considered superior to liquorice on all points. Conclusion: Silicone sealant as a model tendon is cheap, reproducible and a satisfactory alternative to other models of tendon simulation repair, and can be used to provide training opportunities.

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“…Poorly performed procedures can result in poor mobilisation increasing the risks associated with co-morbidities, chronic pain, and higher cut-out rates requiring revision surgery. Simulation is a well-recognised teaching adjunct to train high-risk tasks within a safe and controlled environment to prevent harm to patients (15)(16)(17)(18)(19)(20). Simulation in orthopaedic surgery can be divided into three broad categories: 1) low-fidelity saw bones (dry-lab) 2) virtual reality (VR) and 3) cadaveric (wet-lab) simulation (21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%