How to Build Your Simple and Cost-effective Arthroscopic Skills Simulator

Abstract

Acquisition of arthroscopic skills is not always easy and can be time-consuming. Simulation in arthroscopy improves surgical skills and can bridge the gap between reduced surgical exposure and training time and the need to reach a required level of competency. We propose a method to create a simple and cost-effective arthroscopic skills simulator using readily available materials and a low-cost Web camera available from online shops. This arthroscopic simulation device can be used to improve skills of all levels of trainees at home, in a bioskills laboratory, or in the theater. It can also be used by experienced surgeons to train with instruments and devices before using them for the first time in theaters, thus ensuring safe use and improving patient safety. Further validation as a training tool is needed and should be the focus of additional research, but early results are very promising.

Fig 1

Steps to create Web camera arthroscope. (A) Camera with Universal Serial Bus (USB) cable exiting from the rear of the casing. (B) Water pipe cut into 2 halves (25-cm-long and 15-mm-diameter rigid plastic water pipe). (C) Small cut opposite the camera about 5 cm from the end. This is where the cable of the camera exits. Electrical tape is used to reunite the 2 halves of the pipe. Tape should be wrapped around the pipe in a continuous fashion starting from the camera end. When one is approaching the cut, he or she should pull firmly on the camera cable exiting from the cut and wrap the tape around it. (D) Camera with tilt relative to the pipe, imitating the arthroscope's field of view. (deg, degrees.)

Fig 2

Tips to set up cardboard box. (A) Pack 'n Post shipping box (335 × 250 × 110 mm; Clas Ohlson). (B) Various cardboard boxes can be used. (C) The light source can be a battery-powered light. (D) Torch inside box. (E) A single-use laryngoscope can serve as another light source. (F1) Three light-emitting diode (LED) torch (Oscar). (F2) Waterproof portable 24-LED camping light with hanging hook. (G) Clamps to secure the box. (H) Box with Web camera arthroscope from the side and various instruments that can be used for simulation.

Fig 3

Steps to create cork sanding block and chamois leather. (A) Cork sanding block measuring 110 × 60 × 30 mm. (B) Small piece to be cut from a chamois leather cleaning cloth slightly larger than the cork block. For the 110 × 60 × 30–mm block, the cloth should be cut to 115 × 80 mm. (C) Chamois leather, drawing pins, modesty block, and wood screw. (D) Chamois leather attached to the sanding block with drawing pins and modesty block screwed to the anterior of the cork block.

Fig 4

Drawing tasks. (A, B) A piece of a water pipe is wrapped with electrical tape and attached to the end of a marker pen. (C) Tracing shapes outside the box. (D) Tracing shapes inside the box. (E, F) Images can be sent to a monitor using a long Universal Serial Bus (USB) cable. (G) View from inside the box, showing tracing of objects in a coloring book.

Fig 5

Shapes for tracing.

Fig 6

Additional tasks. (A) Preparation for knot tying. (B) Knot-tying training using box. (C) Block building, viewed from outside. (D) Finished building blocks.

Fig 7

Cuff repair task. (A) Anchor insertion into cork block. (B) Suture passer through chamois cuff. (C) Wire through chamois cuff. (D) One limb of suture through chamois cuff. (E) First knot half-hitch. (F) Second knot half-hitch.

Fig 8

Sixter task. (A) Passing of Sixter through chamois cuff. (B) Suture retrieval. (C) Suture passing through chamois cuff, with wire through chamois cuff. (D) One limb of suture through chamois cuff using Sixter.

Fig 9

Self-assessment forms. (A) Block building. (B) Shape tracing. (C) Self-reported subjective ease during surgery.

Fig 10

How to assemble all parts of simulator.