Assessment of a percutaneous iliosacral screw insertion simulator

TL;DR

This study evaluates a fluoroscopic-guided percutaneous iliosacral screw insertion simulator's educational effectiveness by comparing surgeons' accuracy and radiation exposure during a cadaver experiment.

Contribution

It provides novel evidence on the simulator's ability to reduce X-ray exposure, especially among novices, in surgical training for sacroiliac joint fixation.

Findings

Simulator use decreased average X-ray exposure in surgeons.

Novices benefited most from simulator-assisted training.

No significant difference in iatrogenic index between groups.

Abstract

BACKGROUND: Navigational simulator use for specialized training purposes is rather uncommon in orthopaedic and trauma surgery. However, it reveals providing a valuable tool to train orthopaedic surgeons and help them to plan complex surgical procedures. PURPOSE: This work's objective was to assess educational efficiency of a path simulator under fluoroscopic guidance applied to sacroiliac joint percutaneous screw fixation. MATERIALS AND METHODS: We evaluated 23 surgeons' accuracy inserting a guide-wire in a human cadaver experiment, following a pre-established procedure. These medical trainees were defined in three prospective respects: novice or skilled; with or without theoretical knowledge; with or without surgical procedure familiarity. Analysed criteria for each tested surgeon included the number of intraoperative X-rays taken in order to achieve the surgical procedure as well as an iatrogenic index reflecting the surgeon's ability to detect any hazardous trajectory at the time of performing said procedure. RESULTS: An average number of 13 X-rays was required for wire implantation by the G1 group. G2 group, assisted by the simulator use, required an average of 10 X-rays. A substantial difference was especially observed within the novice sub-group (N), with an average of 12.75 X-rays for the G1 category and an average of 8.5 X-rays for the G2 category. As far as the iatrogenic index is concerned, we were unable to observe any significant difference between the groups.