Summary

Thanks to this study, we were able to show that with a simple but well-structured program of learning the basics of arthroscopy on a VR simulator (45 min to 1 hour per month for 6 months), it was possible to objectively save one year of practical training in arthroscopy compared to the training currently proposed.

Abstract

Background

There is limited literature on the transfer of skills learned on the virtual reality (VR) simulator to the operating room (transfer validity) for arthroscopic training, studies mainly focused on the improvement of performance directly in the VR simulator.

Purpose

The purpose of this multicentre, blinded, controlled trial was to objectively investigate transfer validity of VR simulation for basic knee arthroscopic training.
Study Design: Controlled laboratory study.

Methods

Thirty-six orthopaedic junior residents (postgraduate year one and two, PGY-1 and PGY-2) with no prior experience in arthroscopic surgery were enrolled to receive either standard training about knee arthroscopy surgery (VR- group) or standard training plus additional monthly-fixed one-hour protocol of arthroscopic training on a VR simulator (VR+ group). All the participants answered a questionnaire at the inclusion and succeeded a diagnostic tour and meniscectomy on the VR Knee arthroscopic simulator. Both groups were comparable in terms of performance level in the VR simulator at the inclusion for meniscectomy. After 6 months of training, both groups answered a second questionnaire about their acquired expertise in arthroscopy after the inclusion and performed three exercises: first an arthroscopic partial meniscectomy on a bench-top knee simulator, second, a supervised cadaveric diagnostic knee arthroscopy and third a supervised cadaveric knee partial meniscectomy, assessed independently by two blinded consultant trainers. Training superiority was determined by the outcome measures of the Arthroscopic Surgical Skill Evaluation Tool (ASSET) score.

Results

VR-trained residents performed at a higher level than control group ones, global ASSET difference, p < 0.001; for bench-top meniscectomy, p = 0.03; cadaver knee diagnostic tour, p = 0.04; and for cadaver meniscectomy, p = 0.02. Subgroup analysis by residency year showed a significant difference between the VR-PGY-1 and the other subgroups (VR+ PGY-1; VR+ PGY2 and VR- PGY-2), regardless of the exercise performed. In contrast, there was no significant difference between the VR+ PGY-1 and the PGY-2 subgroups with or without VR training.

Conclusion

This study demonstrated the Transfer Validity of the VR Knee arthroscopy simulator for bench-top model and cadaver model. The results showed that the first-year residents’ subgroup reached the level of second-year residents through this training.
Clinical Relevance: Surgical skill acquired with a VR arthroscopy surgical simulator might safely improve arthroscopy competences in the operating room.