Pedowitz Robert A, Esch James, Snyder Steve
San Diego Sports Medicine and Arthroscopy Fellowships at the University of California, San Diego, California, USA.
Arthroscopy. 2002 Jul-Aug;18(6):E29. doi: 10.1053/jars.2002.33791.
We evaluated a virtual reality shoulder arthroscopy simulator using a standardized skills-assessment algorithm in 3 specific groups with various degrees of surgical expertise. The simulator (Mentice Corp, Gothenberg, Sweden) consists of a computer-based, dual-force feedback system with video monitor. Modeled structures include cartilage, labrum, ligaments, biceps tendon, and rotator cuff. The study included 3 groups of volunteers: group 1, medical students interviewing for orthopaedic residency (n = 35); group 2, orthopaedic residents interviewing for sports medicine fellowship (n = 22); and group 3, experienced faculty at a shoulder surgery course (n = 21). Data were collected anonymously and subjects completed a standardized test protocol designed to assess accuracy and efficiency. Subjects used the probe to "touch" a sphere that appeared at various locations within the joint (11 positions total). The sphere changed location immediately on contact with the tip of the probe. The following parameters were calculated by the computer: time (from touching the first ball until touching the eleventh ball), path ratio (percent of measured path length relative to the ideal path), collisions (number of times the probe / arthroscope contacted any tissue), and injuries (collisions beyond a threshold force). Test time and path ratio differed significantly as a function of surgical experience. There was no significant difference in probe collisions between the groups. Arthroscope collisions and injuries averaged 2 or less in all of the groups. There was significant correlation between path ratio and time to complete the test in groups 1 and 2 (r =.527 and r =.827, respectively, P <.001), but not in group 3 (r =.376, P =.10). There was essentially normal distribution of time performance in groups 1 and 2. Time was shorter and more consistent in group 3, suggesting greater consistency in the experienced surgeons. These data suggest that this arthroscopy simulator facilitates discrimination of arthroscopic skills. Computer-based simulation technology provides a major opportunity for surgical skills development without morbidity and operating room inefficiency.
我们使用标准化技能评估算法，在3个具有不同手术专业水平的特定组中，对一款虚拟现实肩关节镜模拟器进行了评估。该模拟器（瑞典哥德堡的Mentice公司）由一个基于计算机的双力反馈系统和视频监视器组成。模拟的结构包括软骨、盂唇、韧带、肱二头肌肌腱和肩袖。该研究纳入了3组志愿者：第1组为正在申请骨科住院医师职位的医学生（n = 35）；第2组为正在申请运动医学专科 fellowship 的骨科住院医师（n = 22）；第3组为参加肩关节手术课程的经验丰富的教员（n = 21）。数据以匿名方式收集，受试者完成了一项旨在评估准确性和效率的标准化测试方案。受试者使用探头“触摸”出现在关节内不同位置的一个球体（共11个位置）。球体在与探头尖端接触后立即改变位置。计算机计算以下参数：时间（从触摸第一个球到触摸第十一个球）、路径比（测量路径长度相对于理想路径的百分比）、碰撞次数（探头/关节镜接触任何组织的次数）和损伤次数（超过阈值力的碰撞次数）。测试时间和路径比因手术经验不同而有显著差异。各组之间探头碰撞次数无显著差异。所有组的关节镜碰撞和损伤平均为2次或更少。第1组和第2组的路径比与完成测试的时间之间存在显著相关性（分别为r = 0.527和r = 0.827，P < 0.001），但第3组不存在显著相关性（r = 0.376，P = 0.10）。第1组和第2组的时间表现基本呈正态分布。第3组的时间更短且更一致，表明经验丰富的外科医生表现更一致。这些数据表明，这款关节镜模拟器有助于区分关节镜手术技能。基于计算机的模拟技术为手术技能发展提供了一个重要机会，且不会带来发病率和手术室效率低下的问题。
