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Technical Brief

A Force Measurement System for Training of Arthroscopic Tissue Manipulation Skills on Cadaveric Specimen

[+] Author and Article Information
T. Horeman, G. J. M. Tuijthof

Department of Biomechanical Engineeering,
Delft University of Technology,
Delft 2628 CD, The Netherlands;
Academic Medical Centre,
Amsterdam 2628 CD, The Netherlands

P. B. Wulms

Department of Biomechanical Engineeering,
Delft University of Technology,
Delft 2628 CD, The Netherlands

G. M. M. J. Kerkhoffs, R. M. Gerards

Academic Medical Centre,
Amsterdam 1105 AZ, The Netherlands

M. Karahan

School of Medicine,
Acibadem University,
Ataşehir, İstanbul 34758, Turkey

Manuscript received January 20, 2016; final manuscript received June 13, 2016; published online September 12, 2016. Assoc. Editor: Carl Nelson.

J. Med. Devices 10(4), 044508 (Sep 12, 2016) (7 pages) Paper No: MED-16-1011; doi: 10.1115/1.4034145 History: Received January 20, 2016; Revised June 13, 2016

To improve arthroscopic skills, the preferred means of training is cadaveric tissue, because this gives the most realistic scenario. A drawback of cadaveric training is that objective performance tracking and accompanied feedback cannot be provided due to the absence of a suitable system. The main criteria were that the system should be compatible with any cadaveric joint, be used with any type of instrument, easy to set up, and measure two critical parameters that reflect the task efficiency (task time) and safety (forces due to instrument–tissue interaction). This resulted in the development of a force measurement system which consists of a custom-made universal vice, a custom-designed six degree-of-freedom (DOF) force measurement table (FMT) coupled to a computer equipped with customized software to record the time and forces in all directions. The FMT was calibrated and able to measure forces in the range of 0–750 N, with an accuracy of 0.1 N. During two cadaveric training courses, measurements were performed with the FMT. It was observed that the acquired force data could discriminate between novices and experts or reflect a certain phase of a navigation task performed in a cadaveric cow and human knee. A distinct phase highlighted from the force measurements is the insufficient joint stressing of novices during navigation. This results in too small a joint space for inspection and forces the novices to readjust the stressing. As forces cannot be seen, the FMT can contribute to more efficient training by providing explicit cues on the exerted loads during training. This enables a more precise supervision of the trainees.

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References

Reznick, R. K. , 1993, “ Teaching and Testing Technical Skills,” Am. J. Surg., 165(3). pp. 358–361. [CrossRef] [PubMed]
Horeman, T. , Akhtar, K. , and Tuijthof, G. J. , 2015, “ Physical Simulators,” Effective Training of Arthroscopic Skills, Springer, Berlin, pp. 57–69.
Wolf, B. R. , and Britton, C. L. , 2013, “ How Orthopaedic Residents Perceive Educational Resources,” Iowa Orthop. J., 33, pp. 185–190. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748877/ [PubMed]
Mattos e Dinato, M. C. , Freitas, M. F. , and Iutaka, A. S. , 2010, “ A Porcine Model for Arthroscopy,” Foot Ankle Int., 31(2), pp. 179–181. [CrossRef] [PubMed]
Patel, D. , and Guhl, J. F. , 1983, “ The Use of Bovine Knees in Operative Arthroscopy,” Orthopedics, 6(9), pp. 1119–1124. [PubMed]
Splawski, R. , 2011, “ Animal Model of Humeral Joint for Shoulder Arthroscopy Training,” Chir. Narzadow Ruchu Ortop. Pol., 76(6), pp. 324–326. [PubMed]
Unalan, P. C. , Akan, K. , Orhun, H. , Akgun, U. , Poyanli, O. , Baykan, A. , Yavuz, Y. , Beyzadeoglu, T. , Nuran, R. , Kocaoglu, B. , Topsakal, N. , Akman, M. , and Karahan, M. , 2010, “ A Basic Arthroscopy Course Based on Motor Skill Training,” Knee Surg. Sports Traumatol. Arthrosc., 18(10), pp. 1395–1399. [CrossRef] [PubMed]
Madan, S. S. , and Pai, D. R. , 2014, “ Role of Simulation in Arthroscopy Training,” Simul. Healthcare, 9(2), pp. 127–135. [CrossRef]
Butler, A. , Olson, T. , Koehler, R. , and Nicandri, G. , 2013, “ Do the Skills Acquired by Novice Surgeons Using Anatomic Dry Models Transfer Effectively to the Task of Diagnostic Knee Arthroscopy Performed on Cadaveric Specimens?,” J. Bone Jt. Surg. Am., 95(3), pp. e15–e18. [CrossRef]
Slade Shantz, J. A. , Leiter, J. R. , Collins, J. B. , and MacDonald, P. B. , 2013, “ Validation of a Global Assessment of Arthroscopic Skills in a Cadaveric Knee Model,” Arthroscopy, 29(1), pp. 106–112. [CrossRef] [PubMed]
Tuijthof, G. J. , and Sierevelt, I. N. , 2015, “ Monitoring Performance and Progression in the Operating Theatre,” Effective Training of Arthroscopic Skills, Springer, Berlin, pp. 149–163.
Obdeijn, M. C. , van Baalen, S. J. , Horeman, T. , Liverneaux, P. , and Tuijthof, G. J. , 2014, “ The Use of Navigation Forces for Assessment of Wrist Arthroscopy Skills Level,” J. Wrist Surg., 3(2), pp. 132–138. [CrossRef] [PubMed]
Obdeijn, M. C. , Horeman, T. , de Boer, L. L. , van Baalen, S. J. , Liverneaux, P. , and Tuijthof, G. J. , 2014, “ Navigation Forces During Wrist Arthroscopy: Assessment of Expert Levels,” Knee Surg. Sports Traumatol. Arthrosc., epub.
Horeman, T. , 2014, “ Force-Based Assessment of Tissue Handling Skills,” Ph.D. thesis, Delft University of Technology, Delft, The Netherlands.
Tuijthof, G. J. , Horeman, T. , Schafroth, M. U. , Blankevoort, L. , and Kerkhoffs, G. M. , 2011, “ Probing Forces of Menisci: What Levels are Safe for Arthroscopic Surgery,” Knee Surg. Sports Traumatol. Arthrosc., 19(2), pp. 248–254. [CrossRef] [PubMed]
Tashiro, Y. , Miura, H. , Nakanishi, Y. , Okazaki, K. , and Iwamoto, Y. , 2009, “ Evaluation of Skills in Arthroscopic Training Based on Trajectory and Force Data,” Clin. Orthop. Relat. Res., 467(2), pp. 546–552. [CrossRef] [PubMed]
Obeid, E. M. , Adams, M. A. , and Newman, J. H. , 1994, “ Mechanical Properties of Articular Cartilage in Knees With Unicompartmental Osteoarthritis,” J. Bone Jt. Surg., Br., 76(2), pp. 315–319.
Horeman, T. , Rodrigues, S. P. , Jansen, F. W. , Dankelman, J. , and van den Dobbelsteen, J. J. , 2010, “ Force Measurement Platform for Training and Assessment of Laparoscopic Skills,” Surg. Endoscopy, 24(12), pp. 3102–3108. [CrossRef]
Clauser, C. E. , McConville, J. T. , and Young, J. W. , 1969, “ Weight, Volume, and Center of Mass of Segments of the Human Body,” Air Force Systems Command, Wright-Patterson Air Force Base, OH, Report No. AMRL-TR-69-70.
Han, T. S. , and Lean, M. E. , 1996, “ Lower Leg Length as an Index of Stature in Adults,” Int. J. Obes. Relat. Metab. Disord., 20(1), pp. 21–27.
Stunt, J. J. , Wulms, P. H. L. M. , Kerkhoffs, G. M. M. J. , Sierevelt, I. N. , Schafroth, M. U. , and Tuijthof, G. J. M. , 2014, “ Variation in Joint Stressing Magnitudes During Knee Arthroscopy,” Knee Surg. Sports Traumatol. Arthrosc., 22(7), pp. 1529–1535. [CrossRef] [PubMed]
Brooks, T. L. , 1990, “ Telerobotic Response Requirements,” IEEE International Conference on Systems, Man and Cybernetics (ICSMC), Los Angeles, CA, Nov. 4–7, pp. 113–120.
Chami, G. , Ward, J. W. , Phillips, R. , and Sherman, K. P. , 2008, “ Haptic Feedback Can Provide an Objective Assessment of Arthroscopic Skills,” Clin. Orthop. Relat. Res., 466(4), pp. 963–968. [CrossRef] [PubMed]
Howells, N. R. , Brinsden, M. D. , Gill, R. S. , Carr, A. J. , and Rees, J. L. , 2008, “ Motion Analysis: A Validated Method for Showing Skill Levels in Arthroscopy,” Arthroscopy, 24(3), pp. 335–342. [CrossRef] [PubMed]
Escoto, A. , Trejos, A. L. , Naish, M. D. , Patel, R. V. , and LeBel, M. E. , 2012, “ Force Sensing-Based Simulator for Arthroscopic Skills Assessment in Orthopaedic Knee Surgery,” Medicine Meets Virtual Reality 19: NextMed (Studies in Health Technology and Informatics, Vol. 173), IOS Press, Amsterdam, The Netherlands, pp. 129–135.
van den Dobbelsteen, J. J. , Karahan, M. , and Akgün, U. , 2015, “ Theory on Psychomotor Learning Applied to Arthroscopy,” Effective Training of Arthroscopic Skills, Springer, Berlin, pp. 17–32.

Figures

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Fig. 1

The prototype of the FMT for training on cadaver specimen. A: support for bone vice. B: fixation plate that allows fixation of the setup to the operation table.

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Fig. 2

Location of the bending beams with Hall effect sensors and magnets in the x-, y-, and z-plane of the FMT

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Fig. 3

Picture of one bending beam in the z-plane of the FMT loaded to its maximum. At the location where the magnet and Hall sensor are integrated in the upper square and the bending beam, respectively, the deflection is measured. Lower left corner: Schematic illustration of the bending beam with relevant dimensions for stiffness calculation.

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Fig. 4

User interface that allows simultaneous recording of up to six USB camera views

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Fig. 5

Graph of the relation between the sensor–magnet distance and the output voltage of the Hall effect sensor

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Fig. 6

Top view of the fixation points (encircled) and the directions used to test the FMT while loaded with masses of 10 kg (arrows)

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Fig. 7

Test setup that highlights the masses of 20 g that were used to determine the sensitivity of the FMT

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Fig. 8

Top: A human cadaver knee joint is fixated with its femur in the vice of FMT. Additional pins are drilled through the vice to secure the fixation. Below: A cow knee joint is fixated with its femur in the vice of FMT without extra pins, since no leg stressing is required.

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Fig. 9

Force graph of well-performed navigation task

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Fig. 10

Force graph of navigation task in which the participant was not able to insert the instrument in the lateral compartment. The result is high force fluctuations in the Z-direction.

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Fig. 11

Force graph of navigation task in which the initial leg stressing was too low. As a consequence, readjustment of the leg was required to increase the leg stress and increase the working space in the medial compartment.

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Fig. 12

Force graph of navigation task in which the participant used a trocar to puncture the tissue layers before he could enter the lateral compartment with the camera

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Fig. 13

Force graph of a highly unsuccessful navigation task. The arrows indicate the points in which the Fxfilt varies between negative and positive values; and the leg is not stressed as required.

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