Navigating ISHA 2019 with a 70-degree scope

A welcome addition to the ISHA congress program over the last 3 years, Virtual Surgery Simulation Sessions were incorporated into ISHA 2019 in Madrid.

As in the years before, each trainee could follow a standard training course that was created by a collaboration of Dr. sc. tech. Martina Vitz, Head of Training and Education at VirtaMed and Dr. med. Nicolas Bonin, member of ISHA's Educational Team.

Basic skills, such as using the 70-degree scope to arthroscopically explore the hip, were taught as well as more demanding tasks such as triangulation and using a shaver. The realistic features of the simulator were highly appreciated by the trainees, which also allows virtual fluoroscopy to plan portal placement and assessment of cam decompression. This simulator experience is invaluable in knowledge sharing and developing well-rounded expertise across hip preservation.

Trainees were guided through central and peripheral diagnostic cases, followed by triangulation exercises and therapeutic cases. The simulators provided objective performance-based feedback, pointing trainees to focus on specific skills as they progressed. 

Training in such a risk free environment is unfortunately not always possible and the participants agreed that a standardized course will lead to better patient safety during training. It was interesting to see that not only fellows would take the chance of training on the simulator but also experts and physiotherapists. 

Over the course of three days, over 100 ISHA participants trained on the ArthroS™ hip simulators, kindly donated by industry partners Smith+Nephew, KARL STORZ and Zimmer Biomet. 

A Fellow's competition ran throughout the congress, with objective feedback assessing proficiency, safety factors and case completion. Dr. Robert Lawton, who completes his fellowship in southern Germany, achieved the high score with exceptionally efficient use of his camera and his instruments. 

Simulation is still a very new form of surgical training especially in hip arthroscopy, with VirtaMed's hip arthroscopy simulator developed in 2015. Fortunately, the development of the hip simulation module was in collaboration with Prof. Dr. Michael Dienst, which is why the VirtaMed Hip simulators uniquely include training with the proximal anterolateral portal. 

VirtaMed will be happy to join again as an integral part of the educational program of the 2020 congress in Ottawa.

ArthroS™ hip simulator: ISHA recognized course

Exercises 1 and 2: These two exercises consist of a guided diagnostic tour in the central and peripheral compartments of the hip. Virtual fluoroscopy can be used to determine the best position for instruments to enter the different portals. In the peripheral tour the proximal anterolateral portal is proposed for a first approach, and the greater trochanter can be felt to aid scope positioning. The trainee gets an insight on how to navigate with the 70-degree scope and how to manipulate the hip, whether it is traction for access to the central compartment or flexion for the peripheral compartment. 

Exercise 3: Once the knowledge and the manual skills are understood and acquired, the trainee can practice a diagnostic tour by themselves, selecting the portals of their preference. The simulator records the observed landmarks and can be used to highlight any unseen areas if needed. 

Exercises 4- 6: Following diagnostics using the scope, triangulation is trained using a probe and grasper in both compartments in order to palpate landmarks such as the labrum and remove gamified loose bodies.

Exercises 7 and 8: The trainee encounters therapeutic cases. The first is a loose body removal, where the bodies flow away under too much water pressure, and a second where they can practice the use of the semi-hooded burr in the hip for a cam decompression. Virtual fluoroscopy allows the trainer to determine the result of the abrasion at varying rotations. Both interventions require not only the use of the instruments but also a complete diagnostic exploration.

The hip is likely the most difficult joint in which to perform an arthroscopic intervention. The course only gives an insight of the demands on an hip arthroscopist, and the hour-long workshop gives a good assessment of their current abilities. Based on this, it is possible to identify areas for further practice and improvement: for some this is still efficiently mastering the 70-degree scope, for others this is refining their precise use of surgical instruments.