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