Hauschild Jordan, Rivera Jessica C, Johnson Anthony E, Burns Travis C, Roach Christopher J
Brooke Army Medical Center, San Antonio, Texas, USA.
Orthop J Sports Med. 2021 May 10;9(5):23259671211003873. doi: 10.1177/23259671211003873. eCollection 2021 May.
Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures.
PURPOSE/HYPOTHESIS: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale.
Controlled laboratory study.
Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine-trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants' arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired tests.
There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( = .0045) and VR ( = .0003), with no significant difference between the groups.
A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors' hypothesis that the VR simulator would be the more effective simulation tool.
There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.
以往的模拟研究评估了干实验室（DL）或虚拟现实（VR）模拟，将模拟器训练与关节镜手术任务的表现相关联。然而，这些研究并未将模拟训练与特定的外科手术进行比较。
目的/假设：确定肩关节镜模拟器程序在改善关节镜下前盂唇修复手术表现方面的有效性。假设DL和VR模拟方法均能改善手术表现；然而，基于经过验证的关节镜手术技能评估工具（ASSET）整体评分量表，VR模拟会更有效。
对照实验室研究。
纳入一家机构的38名骨科住院医师，他们处于研究生第1至5年。每位住院医师在尸体模型上完成一次肩稳定手术的预测试，然后随机分为两组之一：VR或DL模拟组。参与者随后接受为期4周的关节镜模拟程序并完成后测试。接受运动医学培训的骨科外科医生在手术过程中对参与者手术修复的完整性进行评分，一名单盲骨科外科医生使用ASSET整体评分量表对参与者的关节镜技能进行评分。使用配对t检验比较模拟器组之间以及不同研究生年级之间的手术步骤和ASSET评分。
在手术步骤或ASSET评分的预测试表现方面，两组之间没有显著差异。两种类型的模拟器训练相结合后，总体手术步骤评分有所提高（P = 0.0424），但在各个模拟组中没有提高。DL组（P = 0.0045）和VR组（P = 0.0003）的ASSET评分均有所提高，两组之间没有显著差异。
为期4周的模拟程序可以提高特定外科手术中的关节镜技能和表现。本研究为模拟器训练对新手和经验丰富的关节镜外科医生在骨科手术中的益处提供了更多证据。VR和DL模型之间没有统计学上的显著差异，这推翻了作者关于VR模拟器将是更有效模拟工具的假设。
模拟器训练在关节镜技能教学和特定外科手术学习中可能有作用。
