Abstract
Simulation and surgical training has moved on since its inception during the end of the last century. The trainees are getting more exposed to computers and laboratory training in different subspecialties. More needs to be done in orthopedic simulation in spinal surgery. To develop a training system for pedicle screw fixation and validate its effectiveness in a cohort of junior orthopedic trainees. Fully simulated computer-navigated training system is used to train junior orthopedic trainees perform pedicle screw insertion in the lumbar spine. Real patient computed tomography scans are used to produce the real-time fluoroscopic images of the lumbar spine. The training system was developed to simulate pedicle screw insertion in the lumbar spine. A total of 12 orthopedic senior house officers performed pedicle screw insertion in the lumbar spine before and after the training on training system. The results were assessed based on the scoring system, which included the amount of time taken, accuracy of pedicle screw insertion, and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation, and the number of exposures after the training on simulator system. This was statistically significant using paired Student t test (p < 0.05). Fully simulated computer-navigated training system is an efficient training tool for young orthopedic trainees. This system can be used to augment training in the operating room, and trainees acquire their skills in the comfort of their study room or in the training room in the hospital. The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater.
Highlights
Surgical training has progressed from the era of doing the training on the plastic bone simulator to 3-dimensional (3D) simulation using special monitors and cameras.[1]
All the junior surgical trainees who had not done any spinal surgery and had no previous exposure to computer-assisted orthopedic training system were included in the study
The system does not need to acquire any radiographic images during the surgery, and the images are generated by the computer-assisted orthopedic training system from the computed tomography (CT) scan
Summary
Surgical training has progressed from the era of doing the training on the plastic bone simulator to 3-dimensional (3D) simulation using special monitors and cameras.[1]. The challenges of reduced training opportunities, shortened working hours, and financial pressures[3] have been exemplified by the increased pressures on the hospitals to achieve targets and focus on service provision. Trainees are developing their psychomotor skills in their later years of training, and highly specialized surgeries like spinal surgery are mainly done by the consultants or the fellows who have decided on their subspecialty.[4] Training simulators are available to the selected few, and most trainees have to register to courses and workshops to do simulation for the specific procedures. More needs to be done in orthopedic simulation in spinal surgery
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