Virtual reality simulation in orthopedics and trauma surgery in France : Current status and perspectives

Abstract

The current reduction in working hours and the worldwide attempt to guarantee patient safety have led to significant changes in the training of surgical assistants. Numerous studies meanwhile present arthroscopic virtual reality (VR) simulators as very efficient tools for resident training. Based on ameta-analysis of VR arthroscopy simulators that identified different levels of evidence and validity, the situation in France in 2017/2018 is described in response to the new French law prohibiting access to the operating theater without prior simulator training. A total of 7prospective randomized trials were identified that were conducted between 2008 and 2016 in the field of knee and shoulder simulation training. Of the trials six were designed to assess transfer validity. Only four evaluated the simulation-based transfer of knowledge acquired in training to the operating room using an evaluation scale under real-world conditions with blinded assessors. Although France has not yet participated in transfer validation studies, VR simulator training was tested in afirst national cohort and alarge number of assistants were trained for 6months. Even though evidence that the acquired skills can be validly transferred to the operating theater is still needed, especially for arthroscopy, simulation has already become an indispensable form of further training.