a novel approach to teaching visual-spatial skills in wire navigated procedures jenniefer y. kho,...
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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, PhDUniversity of Iowa Hospitals and Clinics
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Aided by a Grant from the Orthopaedic Research and Education Foundation
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Introduction
Surgical simulation in orthopaedic trauma is lacking
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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.
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Yehyawi et al. A simulation trainer for complex articular fracture surgery. JBJS 2013.
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Blyth. A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 2007.
Virtual Reality Simulator
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Froelich et al. Surgical Simulators and Hip Fracture: A Role in Residency Training? Journal of Surgical Education 2011.
Haptic-based simulator
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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.
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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
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TrakStar simulator development
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Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
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Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
- Tip-apex-distance- Time- # fluoro shots- # of attempts
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Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
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MethodsTAD 20.9mm – 53 images
TAD 17.8mm – 50 images
TAD 12.05mm – 42 images
Trial 1
Trial 2
Trial 3
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Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
- Tip-apex-distance- Time- # fluoro shots- # of attempts
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Methods6 PGY-1 residents
Sawbones pretest
Simulator training (3 trials)
Sawbones posttest
PGY-4/Staff
- Tip-apex-distance- Time- # fluoro shots- # of attempts
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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)
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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
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Trial 1 Trial 2 Trial 30
5
10
15
20
25
PGY-1PGY-4Staff
TAD
(mm
)
Results of simulator practice in all groups
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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
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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)
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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