Several simulators have been created to improve the learning curve of residents in arthroscopy surgery. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handling instruments. The correlation between training on a simulator and improved performance in the operating room has been established in the general surgery literature.1-2 In orthopedics, arthroscopy is an irreplaceable diagnostic and interventional tool. Arthroscopic laboratory simulators have been used in training courses worldwide, and some studies have recently demonstrated validity, objective improvement in performance with training, and transferability of these learned skills to the operating theater.3-4 The aim of this study is to present a new simulator for Shoulder Arthroscopic Surgery, specifically for the articular and subacromial procedures.
This real simulator was built with a synthetic thermo-retractile and a thermosensible rubber. It is possible to use an arthroscopy pump to allow distension and visualization to be maintained during procedures. The fiberglass moulds, in the shape of the humerus and scapula make possible the use of shaver devices and implant of different materials. It is possible to make open surgery like total shoulder arthroplasty. It was performed a survey with 15 experienced arthroscopy shoulder surgeons after procedures. Tasks included probing identified structures, throwing a suture, hook manipulation of identified structures, shaving/burring and resistance compared to normal tissue. Results: There are many possibilities to the training: identification of anatomic landmarks, triangulation skills, perform biceps tenotomy or tenodesis, SLAP repair, Bankart surgery for instability, rotator cuff repair, subacromial decompression and stabilization of acromioclavicular joint dislocation. After survey analysis, 69% answered that the model has minimum distortion when compared to the real anatomical structure and no experienced surgeons can apply on practice. Eight percent (8%) answered that the simulator is very similar when compared to the real anatomical structure.
The authors conclude that this training model can represent a fairly useful method to improve surgical steps required on standard arthoscopy surgery on trainees. This training provides an alternative to use human cadavers and animal models. Furthermore, it can represent the anatomical alteration precisely as well surgical shoulder situations. Simulator training provides an opportunity for surgeons to practice new skills, but a standardized objective measurement scheme to evaluate performance (and improvement) based on simulator use is necessary.
1. Gallagher AG, Seymour NE, Jordan-Black J, Bunting BP, McGlade K, Satava RM. Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition. Ann. Surg. 2013 Jun.;257(6):1025-1031.
2. Korndorffer JR, Dunne JB, Sierra R, Stefanidis D, Touchard CL, Scott DJ. Simulator training for laparoscopic suturing using performance goals translates to the operating room. J. Am. Coll. Surg. 2005 Jul.;201(1):23-29.
3. Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL. Transferring simulated arthroscopic skills to the operating theatre: a randomised blinded study. J Bone Joint Surg Br. 2008 Apr.;90(4):494-499.
4. Howells NR, Brinsden MD, Gill RS, Carr AJ, Rees JL. Motion analysis: a validated method for showing skill levels in arthroscopy. Arthroscopy. 2008 Mar.;24(3):335-342.
5. Henn RF, Shah N, Warner JJP, Gomoll AH. Shoulder arthroscopy simulator training improves shoulder arthroscopy performance in a cadaveric model. Arthroscopy. 2013 Jun.;29(6):982-985.
6. Srivastava S, Youngblood PL, Rawn C, Hariri S, Heinrichs WL, Ladd AL. Initial evaluation of a shoulder arthroscopy simulator: establishing construct validity. J Shoulder Elbow Surg. 2004 Feb.;13(2):196-205.
Marcos Lyra is chief development officer for ProDelphus.