Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Abstract

Background and purpose — Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.Patients and methods — 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.Results — The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.Interpretation — We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

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

“…A number of studies have investigated the improvement in trainee performance on a VR simulator over the course of a training session, or sessions, demonstrating progression along a learning curve (Table III). 26,[36][37][38][39][40][41][42] Pollard et al 38 demonstrated this learning curve for simulated hip arthroscopy with the patient in both lateral and supine positions, measuring time taken, the total path-length of the hands and the number of hand movements, for 20 orthopaedic trainees with minimal hip arthroscopy experience. A similar learning curve was demonstrated using the Sheffield Knee Arthroscopy Training System (University of Sheffield, Sheffield, UK) in both experienced and inexperienced individuals, and a passive haptic knee arthroscopy simulator in medical students.…”

“…The insightMIST (3D Systems, Rock Hill, South Carolina) shoulder VR simulator has also been shown to provide learner progression, supporting VR simulation in shoulder surgical training. 37 Two studies conducted by Sugand et al 40,42 have explored the training effect of both the TouchSurgery application (TouchSurgery Labs, London, United Kingdom) and the TraumaVision Dynamic Hip Screw VR (Swemac, Linköping, Sweden) simulator (3D Systems, Rock Hill, South Carolina), showing progression by medical students and surgical trainees respectively.…”

“…Studies of such simulators have also demonstrated construct validity and learning curve progression but evidence of concurrent validity is still lacking, but remains vital to demonstrate any postulated benefits. [18][19][20]24,34,40 In conclusion, the demonstration of 'real-world' benefits to orthopaedic surgical training of two previously validated simulators for knee and shoulder arthroscopy is highly promising. More investigation of other simulators and of the cost efficiency of the two validated simulators is needed before their implementation into training curricula can be robustly championed.…”

Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study

“…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).…”

Measuring hip fracture fixation guide wire placement for performance assessment in simulation and the operating room

“…Simulation enables surgeons to acquire skill outside of the OR and allows them to practice in a low-pressure situation, providing them with time to think through the process and reflect on their surgical technique [7]. Simulation is also thought to improve a surgeon's accuracy, which is important when aiming for a low TAD and a minimal number of wire insertions all while avoiding drilling the wire into the joint space [17][18][19].…”