By Elizabeth Hofheinz, M.P.H., M.Ed.
How much does virtual reality help in orthopedic procedures—especially amongst inexperienced surgeons? Until now, we didn’t have enough information on that. In new research, a multicenter team recruited 25 first- and second-year medical students with no prior exposure to intramedullary tibial nail insertion.
Their study, “Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial,” appears in the August 4, 2020 edition of Clinical Orthopaedics and Related Research.
Mark Orland, an M.D. candidate at the University of Illinois College of Medicine at Chicago, headed up the study. He told OSN, “As an aspiring surgeon, I wanted to research emerging biotechnology and its impact on surgery and surgical education. I found that virtual reality, as a method of teaching, had not been thoroughly validated in procedures outside of those with small scale movements i.e. laparoscopic or endoscopic procedures. With this in mind, I looked into orthopaedics and found Osso VR, which included SCFE, tibial nail insertions, and several other procedures that required larger movements. This led me to examine virtual reality’s efficacy compared to a technique guide using the tibial nail insertion.”
Eight participants were randomly assigned to the technique guide control group, eight were in the virtual reality group, and nine were in the virtual reality and technique guide group. The authors wrote, “Participants in the virtual reality experimental groups completed the simulation on three separate sessions, at a set interval of 3 to 4 days apart. After 10 to 14 days of preparation, all participants attempted to insert an intramedullary nail into an intact, compact bone-model tibia that lacked surrounding soft tissue.”
“Participants were given written hints if requested, but no other assistance was given. A procedure was considered complete if the nail and screw were properly placed. Procedural accuracy was defined as the number of incorrect steps normalized out of the 16 possible performed. After the procedure, one orthopaedic surgeon assessed a blinded video of the participant performing it so the assessor could not recognize the individual or that individual’s gender. Additionally, the assessor was unaware of which group each participant had been randomized to during the evaluation.”
Mark Orland commented to OSN, “For an intramedullary tibial nail insertion, virtual reality preparation resulted in significantly increased procedural completion and accuracy as well as shorter surgical duration, when compared with technique guide preparation alone. Specifically, surgical completion increased from 25% with the technique guide to 75-78% with virtual reality, the virtual reality groups made about half as many mistakes during the procedure and finished it more than five minutes faster than the technique guide group!”
“I believe findings such as those in the study showcase virtual reality’s potential to translate to tangible improvement in surgical residents’ procedural knowledge and surgical ability, especially in the early years of residency. It can also serve as a way to increase residents’ exposure and knowledge base for uncommon procedures as well as procedures where they had previously relied on technique guides or YouTube videos.”