A Review of Virtual Reality Based Training Simulators for Orthopaedic Surgery

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator

A review of virtual reality based training simulators for orthopaedic surgery

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordThis review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator.Wessex Academic Health Science Network (Wessex AHSN) Innovation and Wealth Creation Accelerator Fund 2014/15Bournemouth Universit

Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

BACKGROUND: Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. METHODS: Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire. RESULTS: A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. CONCLUSIONS: A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training course

Use of Knee Fractures Physical Replicas for Surgical Training and Rehearsal: Proof of Concept Study

In the last years also in orthopedic surgery, there was an increasing interest in the development of surgical simulators using methods of additive manufacturing combined or not with augmented reality systems (hybrid simulators). Aim of this work was to evaluate the use of a new patient’s specific tibial plateau fractures simulator for surgical training of young resident surgeons in fracture fixation with an external fixator. The simulator is a realistic knee phantom including a patient-specific replica of a fractured tibia and fibula, obtained by CT segmentation and rapid prototyping techniques. Each training session started with the presentation, and planning, of the surgical case that it was followed by the external fixation session on the simulator. At the end of each session, all participants were asked to fill out a questionnaire, concerning the phantom realism and appropriateness as a teaching modality. The results of the Likert Questionnaire indicating that there is an overall significant agreement with the phantom realism and its appropriateness as a teaching modality. The solid model of the patient’s anatomy can faithfully reproduce the surgical complexity of the patient and it allows to generate surgical simulators with an increasing difficulty to perform structured training paths: from the "simple" case to the "complex" case. The use of simulators based on 3D models has proved to be a very useful tool both for didactic and surgical training purposes, allowing surgeons to perform a real procedure simulation outside the surgical room

A Microsoft HoloLens Mixed Reality Surgical Simulator for Patient-Specific Hip Arthroplasty Training

Surgical simulation can offer novice surgeons an opportunity to practice skills outside the operating theatre in a safe controlled environment. According to literature evidence, nowadays there are very few training simulators available for Hip Arthroplasty (HA). In a previous study we have presented a physical simulator based on a lower torso phantom including a patient-specific hemi-pelvis replica embedded in a soft synthetic foam. This work explores the use of Microsoft HoloLens technology to enrich the physical patient-specific simulation with the implementation of wearable mixed reality functionalities. Our HA multimodal simulator based on mixed reality using the HoloLens is described by illustrating the overall system, and by summarizing the main phases of the design and development. Finally, we present a preliminary qualitative study with seven subjects (5 medical students, and 2 orthopedic surgeons) showing encouraging results that suggest the suitability of the HoloLens for the proposed application. However, further studies need to be conducted to perform a quantitative test of the registration accuracy of the virtual content, and to confirm qualitative results in a larger cohort of subjects

Affordable interactive virtual reality system for the Dynamic Hip Screw surgery training in vitro

Interactive virtual reality systems provide safe and cost-effective training environment to improve the technical skills and competence of surgeons. The trainees can have as many practice sessions, without need to the trainer all the time, before even start carrying out the procedure on any real patient. In this paper, we present an affordable interactive virtual reality system for the Dynamic Hip Screw (DHS) surgery training in vitro, through 3D tracking. The system facilitates a safe (in vitro / off patient) training to improve the cognitive coordination of trainees and junior surgeons, in particular the Hands, Eyes and Brain coordination. The system is based on very cheap commercial off-the-shelf (COT) components, which are very affordable, and needs minimum setup effort and knowledge. It also provides a range of visual and quantitative feedback information and measures, such as position, orientation, insertion point, and depth of drilling. It is envisaged that improving this level of coordination, through the training system, will contribute to reducing the failure rate of the DHS procedure. This means better treatment for patients and less costs for the Health services systems (e.g. UK's NHS system)

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

AIMS: The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. MATERIALS AND METHODS: A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. RESULTS: A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. CONCLUSION: The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65