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Knee arthroscopic simulation can be used to train speed and gaze strategies in arthroscopic surgery
Author(s):
Mirza Y. (Vereinigtes Königreich)
,
Mirza Y. (Vereinigtes Königreich)
Affiliations:
An V. (Vereinigtes Königreich)
,
An V. (Vereinigtes Königreich)
Affiliations:
Mazomenos E. (Vereinigtes Königreich)
,
Mazomenos E. (Vereinigtes Königreich)
Affiliations:
Vasconcelos F. (Vereinigtes Königreich)
,
Vasconcelos F. (Vereinigtes Königreich)
Affiliations:
Stoyanov D. (Vereinigtes Königreich)
,
Stoyanov D. (Vereinigtes Königreich)
Affiliations:
Oussedik S. (Vereinigtes Königreich)
Oussedik S. (Vereinigtes Königreich)
Affiliations:
ESSKA Academy. Mirza Y. May 9, 2018; 209285; P02-679 Topic: Arthroscopic Surgery
Yusuf Mirza
Yusuf Mirza
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Abstract
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Objectives: Simulation has been advocated as a means to address the reduction in the hours of traditional surgical training. A multitude of reasons including changes in the delivery of surgical care, enhanced levels of patient expectations and the European Working Time Directive have all contributed to decreasing the number of hours a trainee spends in the operating room. Simulation demonstrates an improvement in gaze focus, a quality associated with better surgical proficiency. The value of simulation and its improvement upon gaze focus have yet to be demonstrated in knee arthroscopy.
The objective of our study was to determine whether a knee arthroscopy simulation course improves the gaze fixation strategies of participants.

Methods: Participants (n = 16) were recruited prospectively from two one-day simulation-based knee arthroscopy courses, and were asked to undergo a task at the onset and conclusion of the course, which involved identifying a series of arthroscopic landmarks. The gaze fixation of the participants was recorded with a wearable eye-tracking system. The time taken to complete the task and proportion of time participants spent with their gaze fixated on the arthroscopic stack, the knee model and away from the stack or knee model was recorded. The gaze fixation was measured as a ratio of video frames spent with gaze fixed on screen or the knee model or a distracting object or which could not be recorded divided by the total number of video frames (measures as percentage/ second).
Statistical analysis of recorded parameters (completion time, fixation percentage) took place with the Wilcoxon sign rank test to investigate the differences among the same population between the first and second executions. Differences are deemed significant for p-value < 0.05.

Results: Participants demonstrated a statistically decreased completion time in their second attempts (114.5 seconds) compared to the first (197.5 seconds) (p = 0.001). An improvement in gaze fixation from a first attempt of 86.75% to 91.7% with a statistically significantly increased proportion of gaze focus (p = 0.008) on the screen was also established.
The proportion of time spent fixated on the screen vs. knee model also improved between the first attempt (0.45%/ second) and the second attempt (0.75 %/ second), (p = 0.003)

Conclusions: Simulation improves arthroscopic skills in orthopaedic surgeons, specifically by improving their gaze control strategies as well as decreasing the amount of time taken to identify and mark landmarks in an arthroscopic task.

Keywords:
knee arthroscopy; simulation; education
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