A Novel Approach to Teaching Visual-spatial Skills in Wire Navigated Procedures

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14 Νοε 2013 (πριν από 4 χρόνια)

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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, PhD

University 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

Methods

6 PGY
-
1
residents

Sawbones
pretest

Simulator
training (3 trials)

Sawbones
posttest

Methods

6 PGY
-
1
residents

Sawbones
pretest

Simulator
training (3 trials)

Sawbones
posttest

-

Tip
-
apex
-
distance

-

Time

-

# fluoro shots

-

# of attempts

Methods

6 PGY
-
1
residents

Sawbones
pretest

Simulator
training (3 trials)

Sawbones
posttest

Methods

TAD 20.9mm


53 images

TAD 17.8mm


50 images

TAD 12.05mm


42 images

Trial 1

Trial 2

Trial 3

Methods

6 PGY
-
1
residents

Sawbones
pretest

Simulator
training (3 trials)

Sawbones
posttest

-

Tip
-
apex
-
distance

-

Time

-

# fluoro shots

-

# of attempts

Methods

6 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

0
5
10
15
20
25
Trial 1
Trial 2
Trial 3
TAD (mm)

PGY-1
PGY-4
Staff
Results of simulator practice in all groups

0
10
20
30
40
50
Trial 1
Trial 2
Trial 3
# fluoro shots

PGY-1
PGY-4
Staff
0:00
1:12
2:24
3:36
4:48
Trial 1
Trial 2
Trial 3
Time (min)

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