From the Orthopedic Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile (Morales, Ruz, Filippi, and Villa), the Orthopedic Surgery Department, Complejo Asistencial Dr. Sótero Del Río, Santiago, Chile (Morales), the Orthopaedic and Arthritis Specialist Centre, Sydney, Australia (Lam), the Mercy Medical Center, Baltimore, MD (Cerrato), Facultad de Medicina, Clínica Alemana-UDD, Santiago, Chile (Mococain), and the Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile (Varas).
J Am Acad Orthop Surg. 2024 Aug 15;32(16):e816-e825. doi: 10.5435/JAAOS-D-24-00316. Epub 2024 May 24.
Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS.
A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage.
Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280).
Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters.
This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model.
III.
微创外科（MIS）治疗拇外翻（HV）已越来越受欢迎。然而，采用这种技术面临着明显的学习曲线挑战。本研究旨在通过开发和验证一种创新的模拟模型和培训计划来应对这些挑战，旨在提高 HV MIS 的熟练程度。
根据专家建议，设计了 HV MIS 培训计划和高保真模拟模型。四名没有 MIS 经验的足踝外科医生组成新手组，参加了包括六节指导课程、模拟模型上手练习和即时反馈的培训计划。该计划以尸体手术结束。四名有经验的 MIS 足踝外科医生组成专家组，使用一个模拟模型进行相同的操作。参与者接受了盲法评估，包括客观结构化评估技术技能（OSATS）、手术时间和 X 光片使用情况。
专家对模拟模型的评估表明，他们对解剖学表现、操作性能和作为培训工具的实用性非常满意。在所有结果中，专家组在初始评估中始终优于新手组，表现为 OSATS 得分为 24 分（范围 23 至 25 分），而新手组得分为 15.5 分（范围 12 至 17 分）；中位数手术时间为 22.75 分钟（范围 12 至 27 分钟），而新手组为 48.75 分钟（范围 38 至 60 分钟）；中位数 X 光片使用量为 70 张（范围 53 至 102 张），而新手组为 232.5 张（范围 112 至 280 张）。
新手组从第五次课程开始 OSATS 评分显著提高（P = 0.01），达到 20 分的理想表现。在使用模拟模型进行的最后一次培训中，所有参数的表现与尸体手术结果均无差异。
本研究验证了一种模拟模型和培训计划，使非经验丰富的 HV MIS 足踝外科医生能够提高他们的手术熟练程度，并在第五次课程中有效地完成大部分学习曲线，并且这种表现成功地转移到了尸体模型上。
III 级。
