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Improved arthroscopic-related skill with virtual-reality training in inexperienced surgeon

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Improved arthroscopic-related skill with virtual-reality training in inexperienced surgeon

Vol: 2| Issue: 2| Number:152| ISSN#: 2564-2537
Study Type:Non-Clinical
OE Level Evidence:2
Journal Level of Evidence:N/A

Development of simulated arthroscopic skills

Acta Orthop. 2011 Feb;82(1):90-5. Epub 2011 Feb 1

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21 orthopaedic surgeons participated in this study. 14 inexperienced surgeons were randomized to undergo virtual reality (VR) training for shoulder arthroscopy or no training, while 7 experienced surgeons acted as controls. The primary outcomes were 5-parameters based on the VR unit. Results indicated the inexperienced intervention group showed improvement in arthroscopic skills (based on the VR) unit from the first testing period to the second testing period. The experienced surgeons demonstrated comparable outcomes between both testing periods, while the inexperienced control group demonstrated large variations in the outcomes. Further studies are required to determine the transferability of skills developed from the VR unit into the operating theatre.

Publication Funding Details +
Not Reported
None disclosed

Risk of Bias


Reporting Criteria


Fragility Index


Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.




Outcome Measurements


Inclusion / Exclusion


Therapy Description



Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Previous studies have reported a correlation in performance with virtual reality (VR) training and arthroscopic skills. VR training units may improve an individual's ability to perform invasive surgical techniques. However, no studies have looked at inexperienced orthopaedic surgeon's development in arthroscopic skills with a VR training unit compared to experienced orthopaedic surgeons.

What was the principal research question?

What are the outcomes in arthroscopic skills development when inexperienced orthopaedic surgeons undergo virtual reality (VR) training (for shoulder arthroscopy) compared to experienced surgeons who regularly perform arthroscopic surgery, or compared to inexperienced surgeons who do not receive any VR training?

Study Characteristics -
21 orthopaedic surgeons (14 experienced, 7 inexperienced)
Group 2 (Inexperienced Intervention group): 7 surgeons with no arthroscopic experience received virtual reality training on insightMIST (an advanced arthroscopic VR trainer). Surgeons received a 5-hour training program on the InsightMIST program and were tested twice within 6-15 days. Group 3 (Inexperienced control group): 7 surgeons with no arthroscopic experience received no training
Group 1 (Experienced control group): Experienced surgeons were tested twice on the InsightMIST trainer within 6-15 days (n=7 experienced orthopaedic surgeons)
5 Parameters: Time to complete the exercise, maximum depth of collision with surrounding tissue, number of collisions with surrounding tissue, and paths travelled with both camera and probe.
Mean 10 days

What were the important findings?

  • The inexperienced intervention group saw a reduction in mean arthroscopy time from 720 (SD 239) seconds to 223 (SD 114) seconds (p=0.03 compared to the inexperienced control group).
  • The inexperienced intervention group had a reduction in camera distance traveled from 367 (SD 151) cm to 84 (SD 44) cm (p=0.02 compared to the inexperienced control group).
  • The intervention group had a significantly reduced depth of collision. Number of collisions and distance traveled by probe were also improved (although non-statistically significant).
  • The intervention group showed an improvement in reduced collisions (highest number of collisions from the first test out of all groups, to the lowest number of collisions by the second test), but the improvement was not significant (p=0.07). The number of collisions increased in both control groups from the first to second testing.

What should I remember most?

The intervention group showed great improvements on the 5 tested parameters from the first to second testing period. The experienced control group had comparable results, and the inexperienced control group had large intra- and interpersonal variation. Virtual reality (VR) training units for arthroscopic surgery may help inexperienced surgeons develop basic navigation skills required in arthroscopic surgery procedures.

How will this affect the care of my patients?

Further studies should be performed to determine the transferability of skills from the virtual reality (VR) training unit to the operating theater.

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