The Application Of FAST Simulator In Shoulder Arthroscopy Skill Learning

Background:Arthroscopic surgery has become an indispensable part of joint surgery.In the past,the learning of arthroscopic skills was taught in the“apprenticeship model”.However,with the rapid evolution of surgical techniques and due to ethical and medical costs,it has become unrealistic to obtain surgical skills completely through the teaching of senior doctors or directly in the operating room.To reduce the risk of patient surgery and improve the efficiency of surgery,arthroscopic simulators have been used as an alternative to acquire the skills required for minimally invasive surgery without threatening patient safety.It allows repeated practice and acquisition of skills in a riskless environment,and is able to shorten the learning curve.Prior researches have shown that knee arthroscopic simulator and shoulder arthroscopic simulator(anatomic simulators)are valuable training tools that contribute to the development of arthroscopic skills,and that the skills acquired after training on these simulators can be transferred to practical surgery.However,there is debate about skill transfer from non-anatomical simulators to anatomical simulators.Purpose:1.To investigate whether novices of shoulder arthroscope can improve their performance on shoulder arthroscopic simulator after learning and training on a short-term focused FAST simulator.2.Explore whether the skills acquired by novices on non-anatomical simulator can be transferred to anatomical simulator.Materials and Methods:Twenty-eight novices with no experience in arthroscopy were recruited to perform a pre-test on a shoulder arthroscopic simulator.Then they were randomized into two groups:The experimental group practiced the five module tasks on the FAST simulator and needed to practice the score of each task to full score,and the control group did nothing.The experimental group performed a post-test immediately after FAST simulator practice.Control group rested for 70 minutes after experiencing pre-test before performing post-test.All parameters and videos were recorded by the simulator.Results:The experimental group outperformed the control group in terms of total score(114.21 vs 108.17,P=.022),procedure time(253.29 vs 328.75 s,P=.017),camera path length(141.00 vs 192.00 cm P=.015),and grasper path length(89.50 vs 147.50 cm P=.004).However,there was no statistical difference in scratching of humerus cartilage(0.052 vs 0.053%,P=.667)or glenoid cartilage(0.014 vs 0.012%,P=.860).Significant differences were found in the improvement of both groups in total score(5.00 vs 0.5,P=.011),procedure time(-84.21 vs-12.50 s,P=.018),and camera path length(-60.79 vs-4.58 cm,P=.019).Conclusion:1.After short-term focused skill training on the FAST simulator,novices can improve their performance on the shoulder arthroscopic simulator,reducing the task completion time and camera path length but no significant reduction in cartilage damage.2.The skills acquired by novices on non-anatomical simulator can be transferred to anatomical simulator.This study provides important evidence for the development of shoulder arthroscopic skills training programs in the future.