Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 11, pp 3684–3692 | Cite as

Navigation forces during wrist arthroscopy: assessment of expert levels

  • Miryam C. Obdeijn
  • Tim Horeman
  • Lisanne L. de Boer
  • Sophie J. van Baalen
  • Philippe Liverneaux
  • Gabrielle J. M. Tuijthof
Experimental Study

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Wrist arthroscopy Forces Experts Skills assessment Education 

Notes

Acknowledgments

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.

References

  1. 1.
    Atzei A, Luchetti R, Sgarbossa A, Carità E, Llusà M (2006) Set-up, portals and normal exploration in wrist arthroscopy. Chir Main 25(Suppl 1):S131–S144CrossRefPubMedGoogle Scholar
  2. 2.
    Chami G, Ward J, Wills D, Philips R, Sherman K (2006) Smart tool for force measurements during knee arthroscopy: in vivo human study. Stud Health Technol Inform 119:85–89PubMedGoogle Scholar
  3. 3.
    Chmarra MK, Bakker NH, Grimbergen CA, Dankelman J (2006) TrEndo, a device for tracking minimally invasive surgical instruments in training setups. Sens Actuators A Phys 126:328–334CrossRefGoogle Scholar
  4. 4.
    Chmarra MK, Grimbergen CA, Dankelman J (2007) Systems for tracking minimally invasive surgical instruments. Minim Invasive Ther Allied Technol 16:328–340CrossRefPubMedGoogle Scholar
  5. 5.
    Haisman JM, Bush M, Wolfe S (2005) Wrist arthroscopy: standard portals and arthroscopic anatomy. J Am Soc Surg Hand 5(3):175–181CrossRefGoogle Scholar
  6. 6.
    Hui Y, Safir O, Dubrowski A, Carnahan H (2013) What skills should simulation training in arthroscopy teach residents? A focus on resident input. Int J Comput Assist Radiol Surg 8(6):945–953CrossRefPubMedGoogle Scholar
  7. 7.
    Hofstad EF, Vapenstad C, Chmarra MK, Lango T, Kuhry E, Marvik R (2013) A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. Surg Endosc 27(3):854–863CrossRefPubMedGoogle Scholar
  8. 8.
    Horeman T, Rodrigues SP, van den Dobbelsteen JJ, Jansen FW, Dankelman J (2012) Visual force feedback in laparoscopic training. Surg Endosc 26(1):242–248CrossRefPubMedGoogle Scholar
  9. 9.
    Horeman T, Rodrigues SP, Jansen FW, Dankelman J, van den Dobbelsteen JJ (2012) Force measurement platform for training and assessment of laparoscopic skills. Surg Endosc 26(4):1005–1009CrossRefPubMedGoogle Scholar
  10. 10.
    Horeman T, van Delft F, Blikkendaal MD, Dankelman J, van den Dobbelsteen JJ, Jansen F-W (2014) Learning from visual force feedback in box trainers: tissue manipulation in laparoscopic surgery. Surg Endosc 28:1961–1970PubMedGoogle Scholar
  11. 11.
    Horeman T, Dankelman J, Jansen FW, van den Dobbelsteen JJ (2014) Assessment of laparoscopic skills based on force and motion parameters. IEEE Trans Biomed Eng 61(3):805–813CrossRefPubMedGoogle Scholar
  12. 12.
    Horeman T, Blikkendaal MD, Feng D, van Dijke A, Jansen F, Dankelman J, van den Dobbelsteen JJ (2014) Visual forces feedback improves knot-tying security. J Surg Educ 71(1):133–141CrossRefPubMedGoogle Scholar
  13. 13.
    Mabrey JD, Reinig KD, Cannon WD (2010) Virtual reality in orthopaedics: is it a reality? Clin Orthop Relat Res 468:2586–2591CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Modi CS, Morris G, Mukherjee R (2010) Computer-simulation training for knee and shoulder arthroscopic surgery. Arthroscopy 26:832–840CrossRefPubMedGoogle Scholar
  15. 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
  16. 16.
    Obdeijn MC, van Baalen SJ, Horeman T, Liverneaux P, Tuijthof GJ (2014) The use of navigation forces for assessment of wrist arthroscopy skills. J Wrist Surg 3(2):132–138CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Richards C, Rosen J, Hannaford B, Pelligrini C, Sinanan M (2000) Skills evaluation in minimally invasive surgery using force/torque signatures. Surg Endosc 14:791–798CrossRefPubMedGoogle Scholar
  18. 18.
    Rodrigues SP, Horeman T, Dankelman J, van den Dobbelsteen JJ, Jansen FW (2010) Suturing intraabdominal organs: when do we cause tissue damage? Surg Endosc 24:3102–3108CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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)
  20. 20.
    Tashiro Y, Miura H, Nakanishi Y, Okazaki K, Iwamoto Y (2009) Evaluation of skills in arthroscopic training based on trajectory and force data. Clin Orthop Relat Res 467:546–552CrossRefPubMedGoogle Scholar
  21. 21.
    Tuijthof GJM, Horeman T, Schafroth MU, Blankevoort L, Kerkhoffs GMMJ (2011) Probing forces of menisci: what levels are safe for arthroscopic surgery? Knee Surg Sports Traumatol Arthrosc 19:248–254CrossRefPubMedGoogle Scholar
  22. 22.
    Van Hove PD, Tuijthof GJ, Verdaasdonk EG, Stassen LP, Dankelman J (2010) Objective assessment of technical surgical skills. Br J Surg 97:972–987CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Miryam C. Obdeijn
    • 1
  • Tim Horeman
    • 2
  • Lisanne L. de Boer
    • 3
  • Sophie J. van Baalen
    • 3
  • Philippe Liverneaux
    • 4
  • Gabrielle J. M. Tuijthof
    • 2
    • 5
  1. 1.Department of Plastic, Reconstructive and Hand Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamNetherlands
  2. 2.Department of Biomechanical EngineeringDelft University of TechnologyDelftNetherlands
  3. 3.Department of Technical Medicine, MIRA Institute for Biomedical Technology and Technical Medicine EnschedeUniversity of TwenteEnschedeNetherlands
  4. 4.Department of Hand SurgeryStrasbourg University HospitalsIllkirchFrance
  5. 5.Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical CenterUniversity of AmsterdamAmsterdamNetherlands

Personalised recommendations