Summary

Virtual surgical preceptorship and lab proctorship are effective in teaching complex arthroscopic techniques, such as the AAGR technique, thus overcoming the logistical challenges posed by traditional in-person surgical training.

Abstract

Background

Teaching of innovative surgical techniques to surgeons worldwide pose logistical challenges particularly during and post-COVID-19 pandemic. Arthroscopic Anatomic Glenoid Reconstruction (AAGR) provides improved patient outcomes and low complication rates for treatment of recurrent shoulder instability. A live remote preceptorship has been utilized to mitigate logistical challenges associated with in person learning. The learner connects virtually in the operating room or cadaveric lab with the use of a virtual meeting software, multiple camera angles, and augmented reality with real time feedback.

Methods

Surgeons (i.e., participants) participated in a virtual preceptorship and lab proctorship both instructed by the senior surgeon. Following the preceptorship and proctorship, surveys were sent out to the 44 arthroscopic shoulder surgeons who participated. In addition, the participants were evaluated on key aspects during the virtual lab proctorship. The evaluated adoption, utilization and efficiency of this technique in the learner’s clinical practice before and within the first year after the training was summarized.

Results

Most learners had over five years of experience, with 75% of surgeons performing the AAGR within their first year after training. A majority reported a significant boost in their confidence and comfort with the procedure almost immediately. All participants noted improvements in the overall success of key surgical steps. The most common complication observed during the virtual lab was graft malpositioning, affecting fewer than 20% of participants.
A year or more after the lab preceptorship and proctorship, 80% of participants reported incorporating AAGR into their practice, though many continued to use the open Latarjet technique for bone block procedures as well. Every participant indicated self-reported improvements in key aspects of the surgical approach. However, 44% encountered complications, primarily due to graft malpositioning. Additionally, hospital administration challenges and the cost of the procedure were cited as barriers to adopting the AAGR technique.

Conclusion

The virtual preceptorship and lab proctorship have demonstrated effectiveness in teaching the AAGR technique, overcoming logistical challenges posed by traditional in-person training, especially during the COVID-19 pandemic. The results indicate that the majority of participants quickly incorporated AAGR into their practice, reporting enhanced confidence and improved surgical outcomes. However, some complications, particularly graft malpositioning, persisted, underscoring the need for continued practice and refinement. Despite these challenges, the overall positive reception and integration of AAGR suggest that virtual training programs could play a crucial role in the ongoing education of surgeons worldwide. Further efforts should focus on reducing procedural costs and addressing administrative barriers to facilitate broader adoption of this innovative technique.