Est-ce que la formation sur simulateur permet d’améliorer la triangulation et la précision en arthroscopie d’épaule ? Essai contrôlé randomisé

Abstract

Introduction The dexterity skills required to perform safe, effective and efficient arthroscopic operations are demanding. A variety of arthroscopic surgical simulation models are available, however, the cost of nearly all available models makes them prohibitive for incorporation into the vast majority of orthopaedic training programs. The purpose of this study was to determine the effectiveness of simulator training on basic triangulation and probing skills utilizing a novel, low-cost arthroscopic triangulation training system (ArthroBox, Arthrex Inc., Naples FL). Methods A randomized controlled trial of subjects without prior arthroscopic skills training was conducted. All participants received a demonstration of how to use the arthroscopic triangulation training system and then were randomized to receive either no training or a fixed protocol of simulation training on the simulation model, including 30 minutes of training for 4 consecutive days. On day 1 and day 5, all participants were evaluated on 3 simulated arthroscopic tasks and were assessed by an independent observer. Variables analyzed included which hand the camera was held, which portals the participant initially used, how many times portals were changed, the time it took to complete the tasks and the task completion rate. Statistical analysis was conducted utilizing Student's t -tests, with P > 0.05 denoting statistical significance (OriginPro 9 software, Northampton MA, USA). Results Thirty-six participants (92% male, average age 28 ± 5 years) were randomized into two groups with 17 in the training group (T) and 19 in the no-training group (NT). On day 1, 7/17 participants (41%) in the T group completed all tasks, while 10/19 participants (53%) in the NT group completed all tasks ( P = 0.52). On day 5, significantly more participants in the T group completed all tasks on day 5 compared to the NT group (17/17 (100%) versus 12/19 (63%), P = 0.008). Participants in the T group had significantly improved task completion times for all 3 tasks on day 5 versus day 1. Participants in the NT group had a significantly improved task completion time for task 1 on day 5 versus day 1; no differences were found for tasks 2 and 3. On day 5, participants in the T group required significantly fewer portal changes compared to the NT group (2.35 ± 2.29 versus 6.95 ± 8.55, P = 0.039). Conclusions Simulation training on a simple, low-cost arthroscopic triangulation training system resulted in an overall improvement in arthroscopic probing and triangulation skills within 1 week of training, with significantly decreased task completion times and significantly increased efficiency of movement.