Validation of Simendo Knee Arthroscopy Virtual Reality Simulator

Editorial Commentary: Arthroscopic Simulators—Are We There Yet?

“…There are many challenges associated with simulation training, including cost, validity, and reliability of simulator models, as well as the ability to transfer knowledge and/or skills learned to the actual operating room, among others. [1][2][3][4][5] In this issue, van der Heijden, Reijman, van der Steen, Janssen, and Tuijthof 6 look into the face and construct validity, as well as the educational value and user-friendliness, of a virtualreality (VR) arthroscopic knee simulator in their article "Validation of Simendo Knee Arthroscopy Virtual Reality Simulator." As a quick reminder, face validity assesses how closely the simulator model can replicate the true environment whereas construct validity focuses on determining arthroscopic ability and the ability to discriminate between skill levels (i.e., novice vs intermediate vs expert).…”

“…Van der Heijden et al 6 enrolled 60 subjects with varying degrees of arthroscopic experience, including novices (0 prior arthroscopic procedures), intermediates (1-59 prior arthroscopic procedures), and experts (60 prior arthroscopic experiences). The subjects were medical graduate students, residents, and staff of the investigators' orthopaedic residency program.…”

“…As might be expected, more experts than novices were able to complete all 5 trials of the navigation task within the provided 10 minutes, with only 20% of the novices able to complete all 5 trials within the time constraints. Notably, van der Heijden et al 6 indicated that 95% of participants reported sufficient user-friendliness and 92% of participants agreed that "training of arthroscopic knee inspection is very well possible with the simulator." The lack of simulator-produced tactile feedback seemed to be a limiting factor in these results.…”

“…Thus, validation studies such as these are necessary. One major strength of this study is that van der Heijden et al 6 applied similar methodology to the validation testing of 4 other simulators on the market (PASSPORT simulator, ArthroS, InsightArthroVR, and Toltech), 7-9 making comparisons feasible. Of interest, they do disclaim that one of the coauthors was the project leader in the development of 1 of these competing simulators (PASSPORT).…”

“…Although, certainly, hand-eye coordination is critical for performing surgery and especially arthroscopy, the value of any VR simulator that does not provide tactile feedback, in comparison with a non-VR homemade or box-type arthroscopy trainer, [10][11][12][13][14][15] is unclear. It is interesting that at the end of their article, van der Heijden et al 6 note that at the hospital where this study was performed, residents are required to pass the Simendo training curriculum before performing arthroscopies on patients. Although, in theory, training in an environment in which it is impossible to cause patient harm (i.e., simulator) is ideal, we must strive to understand the value of simulation training in achieving our desired goals, particularly in light of resident work-hour restrictions.…”