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General purpose

Simulation of surgical procedures aims to teach practical skills outside the operating room. It is necessary for safety and organizational reasons related to the working of health facilities and the time constraints of teachers and students. In France, it has been officially included in the medical and surgical training resident national programs since 2017. Virtual reality (VR) simulation is a tool that complements traditional techniques on models, or cadaveric subjects. It is particularly suitable for learning arthroscopy skills (1) whose visual feedback for the operator is done through a 2D TV screen, as similar to how such procedures are conducted in the Operating Room (OR). Significant research has been devoted to the development of these tools and their use. In a recent meta-analysis (2,3), two main drawbacks were outlined: the small number of cohorts of subjects trained and evaluated on their learning curve; the difficulty in distinguishing performance levels with traditional metrics (such as duration and path length) in homogeneous populations. The objective of this thesis is to evaluate the interest of virtual reality simulation in arthroscopy practical learning among orthopedic surgeons with different levels of expertise.


Individual performance classification on a virtual reality arthroscopy simulator by analyzing instrument trajectories during meniscectomy

A preliminary work conducted at MediCIS demonstrated statistically significant correlation between shoulder arthroscopic virtual-reality simulator results and surgical experience (confirmed and expert) about loose-body removal. Motion smoothness and economy of motion were more discriminative of surgical technical expertise than path length. It was also demonstrated that clustering analysis using dynamic time warping was able to reliably discriminate between expert operators and confirmed operators. The goal of this study is now to compare levels of expertise (novice, confirmed and experts) about a more realistic and complex surgical procedure. For our project, meniscectomy will be the standard procedure for arthroscopic knee surgery.

Contribution of training on virtual reality arthroscopy simulator for meniscectomy

The first cohort of orthopedic surgery residents will follow a standardized training of monthly rhythm on an arthroscopy virtual reality simulator. The second cohort of orthopedic surgery residents will benefit from the usual training without VR arthroscopic training. After five months of training, they all will perform a meniscectomy on a cadaver knee and on a bench-top simulated knee. They will be evaluated with the Objective Assessment of Arthroscopic Skills (OAAS) Score by an independent expert arthroscopic knee surgeon. The purpose of the study is to compare virtual reality practical training to the usual training for learning basic arthroscopic skills.


1. Kinematic performance on virtual reality arthroscopy simulator correlate with experience level using clustering. A Tronchot, J Berthelemy, M Le Duff, A Huaulmé, H Common, P Walbron, F Sirveaux, H Thomazeau, P Jannin. Oral Presentation & E-Poster. SFA Research Day 2019,


1. Walbron P, Common H, Thomazeau H, et al. Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res. Published online April 2020
2. Frank RM, Wang KC, Davey A, et al. Utility of Modern Arthroscopic Simulator Training Models: A Meta-analysis and Updated Systematic Review. Arthrosc J Arthrosc Relat Surg. 2018;34(5):1650-1677.
3. Aïm F, Lonjon G, Hannouche D, Nizard R. Effectiveness of Virtual Reality Training in Orthopaedic Surgery. Arthrosc J Arthrosc Relat Surg. 2016;32(1):224-232.

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