Navigation forces during wrist arthroscopy: assessment of expert levels
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To facilitate effective and efficient training in skills laboratory, objective metrics can be used. Forces exerted on the tissues can be a measure of safe tissue manipulation. To provide feedback during training, expert threshold levels need to be determined. The purpose of this study was to define the magnitude and the direction of navigation forces used during arthroscopic inspection of the wrist.
We developed a set-up to mount a cadaver wrist to a 3D force platform that allowed measurement of the forces exerted on the wrist. Six experts in wrist arthroscopy performed two tasks: (1) Introduction of the camera and visualization of the hook. (2) Navigation through the wrist with visualization of five anatomic structures. The magnitude (Fabs) and direction of force were recorded, with the direction defined as α being the angle in the vertical plane and β being the angle in the horizontal plane. The 10th–90th percentile of the data were used to set threshold levels for training.
The results show distinct force patterns for each of the anatomic landmarks. Median Fabs of the navigation task is 3.8 N (1.8–7.3), α is 3.60 (−54–44) and β is 260 (0–72).
Unique expert data on navigation forces during wrist arthroscopy were determined. The defined maximum allowable navigation force of 7.3 N (90th percentile) can be used in providing feedback on performance during skills training. The clinical value is that this study contributes to objective assessment of skills levels.
KeywordsWrist arthroscopy Forces Experts Skills assessment Education
The authors would like to thank the experts who participated in this study. Furthermore, we would like to thank Storz for supplying the instruments and arthroscopy camera for the measurements, and the personnel of the IRCAD laboratories for their kind cooperation during the study.
Conflict of interest
Dr. Obdeijn and Tuijthof and Ms. de Boer and van Baalen have no conflicts of interest or financial ties to disclose. Tim Horeman works as a PhD. researcher at the TU Delft and is partly involved as director of technology and organization at MediShield BV. The ForceTRAP was developed in collaboration between Medishield and the MISIT lab of TU Delft only for non-commercial purposes and was modified for the present study on request. Dr. Liverneaux is a consultant for Newclip Technics, SBI, Argomedical and Integra. None of the authors received financial support for this study.
- 15.Obdeijn MC, Bavinck N, Mathoulin C, van der Horst CM, Schijven MP, Tuijthof GJ (2013) Education in wrist arthroscopy: past, present and future. Knee Surg Sports Traumatol Arthrosc 9 [Epub ahead of print]Google Scholar
- 19.Shore EM, Lefebvre GG, Grantcharov TP (2014) Gynecology resident laparoscopy training: present and future. Am J Obstet Gynecol 25: doi: 10.1016//ajog2014.07.039 (Epub ahead of print)