SimBox 2: An inexpensive universal arthroscopic shoulder simulator

Abstract

Abstract: We have developed and validated an inexpensive shoulder simulator using addition layer prototyping on a domestic 3D printer funded by the £500 prize from the 2015 BOA simulation award. This extension of the previous work is designed to facilitate cost-effective practice of more complex arthroscopic procedures. The simulator comprises an opaque plastic box with holes representing standard shoulder portals. It has an integrated LED light and an extended base to allow secure fixation to a work surface. Internal rails house an anatomically correct humeral head and glenoid. The glenoid component has a soft flexible labrum. The reusable box costs £45 to print. The glenoid costs £5. An “arthroscope” was built using a commercially available zero degree USB LED endoscope (£5.75) housed in a tube with a 3D printed handle, the image is viewed on a laptop. We validated the box using an anterior stabilisation simulation procedure, as this has previously been the subject of published research into complex shoulder arthroscopy training and simulation. All aspects of the procedure including capsulolabral preparation, suture and anchor placement were simulated. Volunteers representing a range of arthroscopic experience were given an instructional video comprising a narrated “live” and simulated procedure. They were able to view this as many times as they wished before carrying out the procedure under supervision. Time taken and errors made were recorded using a modification of a previously validated assessment. The volunteers were also asked to rate the simulator. A direct correlation was seen between experience and all of the variables measured. The feedback regarding face validity was excellent. The low cost allows this simulator to be used by a trainee at home. In a formal environment the box can be used with any standard arthroscopic stack light source and camera to give a more immersive simulation experience.

Full text


SimBox 2
An inexpensive universal arthroscopic shoulder simulator
JTyler,JMoffatt,HColaço,MArnander,EPearse,TDTennent

Disclaimer
•MrTDTennent:ConsultancycontractwithArthrex,
RoyaltiesfromArthrex
•All:FellowshipsupportfromArthrex
•BOAsimulationprize2015usedtofunddevelopment
costs

Introduction
•Arthroscopicsimulatorsfallinto2
broadcategories:
–Highfidelity;highpricedsimulators
eg.Simbionixarthromentor
–Lowfidelity;lowerpricedsimulator
egAlexIIShoulderprofessor

Generation1ShoulderBox
•Opaque“ReallyUseful
Box”
•Simpleproceduresand
triangulation
•Verycheap
•FaceValiditycouldbe
improved
•Complextasksnot
possible

Aim
•Toimprovethefacevalidityofourprevioussimulator
•Indoingso:Createahighlydetailedportablereusableuniversal
shouldersimulatorataverylowprice
–Allowrepeatedusebyatrainee(practice)
–Allowmultipledifferentprocedurestoberehearsed
•Toassestheconstructandfacevalidityoftheprototypesimulator

TheSimulator
Parts:
•Opaqueplasticbox
•Glenoidwithlabrum
•Humeralhead
•USBLEDendoscope
•AlaptopwithUSBport
Construction:
•Additionlayermanufacturing
•HumerusandGlenoidplans
developedfromCTscan

Costs
•DevelopmentCosts:
–£500fundedbylastyearsprize.
•FabricationCosts:
Part
Construction
Cost
Simulation box/housing
Fused deposition modeling
(3Dprint ed) plast ic
£45
Glenoid
Fused deposition modeling
(3Dprint ed) plast ic
£5
Labrum
Fused deposition modeling
(3Dprint ed) elast oplastic
£10
Humeral head
Fused deposition modeling
(3Dprint ed) plast ic
£5
Arthroscope
Handle
Fused deposition modeling
(3Dprint ed) plast ic with metal
sleeve
£10
Optics
Zero degree USB LED
endoscope
£5.75
TOTAL: £80.75

Validation
•Anteriorstabilisationsimulation
–Complexarthroscopictechniquewithmultiplelinkedsteps
–Previouslyusedinsimulationvalidation
–Publishedstepsandmetricanalysis
•Ourvalidationprocedure
–11minuteintroductoryvideo
–3minuteorientationandequipmentbriefing
–ConstructValidation:
–Timedanteriorstabilisation(singleanchor)
–Metricanalysis(usingmodifiedpublisheddescription)
–FaceValidation:
–RatingofsimulatorbyparticipantsusingLikertscale
–Qualitativefeedback

Participants
•Number: 10
•Sex: 7male,3female
•Age: 27-50(mean39)
•Handdominance: 100%RHD
•Hoursofcomputergames/week: 100%0hours/week
•Grades:
–Coretrainees: 2
–STtrainees: 2
–PostCCTfellows: 2
–Consultants: 3(plus1withdrawn)
•Experience:0-7000shoulderarthroscopies
–Novice  (Noexperience): 3
–Intermediate 5-99: 3(plus1withdrawn)
–Advanced 100+:3


RecordedMetrics
•TimeTaken
•NumberofPrompts
•NumberofErrors
•NumberofSentinelErrors
–(Seriouserrorsthatwould
compromisethefinalresult)

ConstructValidity(MetricResults)
Time Prompts

ConstructValidity(MetricResults)
Errors SentinelErrors

FaceValidity(Feedback)
•100%foundtheexerciseinteresting
•100%thoughtthissimulatorcouldbeusedinan
intermediatearthroscopycourse
•87.5%thoughtthissimulatorcouldimprovetheir
arthroscopicskills
•87.5%agreedthesimulatorwasportable,welldesigned,
easytouseandwoulduseitiftheyweregivenone.

FaceValidity(Qualitativefeedback)
•Veryusefultolearnproceduralsteps
•A30Degreescopewouldbeideal
•Labralanatomynotperfect2X
•Provideaclampforthedesk
•Tighterportals

Conclusion
•ThissimulatorshowsExcellent
–Facevalidity
–ConstructValidity
•Thissimulatoris:
–Easytouse
–Portable
–Welldesigned
–Costefficient
•Thenextiterationwillhaveamodifiedglenoidlabrum
•Newinsertsforotherprocedures
•The3Dprintingplanswillbemadeavailableforotherstoreplicate

Questions

Metricanalysisgrid
Modifiedfrom:
AngeloRL,RyuRKN,PedowitzRA,Beach
W,BurnsJ,DoddsJ,etal.
AProficiency-BasedProgressionTraining
CurriculumCoupledWithaModel
SimulatorResultsintheAcquisitionofa
SuperiorArthroscopicBankartSkillSet.
Arthroscopy.2015Oct;31(10):1854–71.

Datacollectionforms
Shoulder Simulation Box2– Validation Study
JKJTyler, HBColaço, M Arnander, EOPearse, TDTennent
Number:
Age:
Sex:
Hand dominance:
Levelof videogameexperience(hoursper week):
Levelof surgical experience:
Medical Student / FoundationDoctor
Consider career in Surgery / Orthopaedics?:
Consultant/ OrthopaedicTrainee(CT 1, 2,3: ST3, 4, 5,6, 7, 8 Fellow)
Are youanarthroscopic surgeon: YES:NO
Number of arthroscopiesperformedi n t otal:
Number of shoulderarthroscopiesperformed:
Attempt
Time(min:sec)
Number of
minorerrors
Number of
majorerrors
Number of
Prompts
1
FEEDBACK
Haveyou attendedan arthroscopicSkillscourse?
Yes
No
Doyou think this could improveyour arthroscopicskills?
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
If given an arthroscopic trainingkit, would you use it?
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
Practicewith this boxcould improveatt empts at arthroscopic surgery?
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
Didyou find the exercise interesting?
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
The simulator waseasyto use:
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
The simulator is easi ly portable:
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
The simulator iswell designedand const ructed:
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
Could thisbe integrated into an intermediate shoulderarthroscopy course?
strongly
disagree
disagree
neither agree
nor disagree
agree
strongly
agree
Other feedback:

Upper Limb Unit
Mr Duncan Tennent – Consultant Orthopaedic Surgeon
Mr Yemi Pearse – Consultant Orthopaedic Surgeon
Mr Magnus Arnander – Consultant Orthopaedic Surgeon
Mr James Tyler – Orthopaedic Clinical Fellow
Mrs Helen Hingston – Orthopaedic Physiotherapy Practitioner
Mrs Debra Garcia – Secretary/PA
CONSENT FORM: Shoulder Arthrosco py Simulation Box 2 Validation Study


I ……………………………….…. consent to ano nymized data collected from this study in the
form of task completion time, metrics and question naire answers to be used for research
purposes.


Signed……………………………………… Date………………..








MrHenryColaço   MrJamesTyler




 

MrDuncanTennent   MrYemiPearse   MrMagnusArnander


Trauma and Orthopaedics
StGeorge’sUniversityHospitals
NHSFoundationTrust
BlackshawRoad
London
SW170QT
Tel:02087252032
Email:admin@sgsu.co.uk