Abstract
Background
Revision total knee arthroplasty (rTKA) is a high stakes procedure with complex equipment and multiple steps. For rTKA using the ATTUNE system revising femoral and tibial components with sleeves and stems, there are over 240 pieces of equipment that require correct assembly at the appropriate time. Due to changing teams, work rotas, and the infrequency of rTKR, scrub nurses may encounter these operations infrequently and often rely heavily on company representatives to guide them. In turn, this delays and interrupts surgical efficiency and can result in error. This study investigates the impact of a fully immersive virtual reality (VR) curriculum on training scrub nurses in technical skills and knowledge of performing a complex rTKA, to improve efficiency and reduce error.
Method
Ten orthopaedic scrub nurses were recruited and trained in four VR sessions over a 4-week period. Each VR session involved a guided mode, where participants were taught the steps of rTKA surgery by the simulator in a simulated operating theatre. The latter 3 sessions involved a guided mode followed by an unguided VR assessment. Outcome measures in the unguided assessment were related to procedural sequence, duration of surgery and efficiency of movement. Transfer of skills was assessed during a pre-training and post-training assessment, where participants completed multi-step instrument selection and assembly using the real equipment. A pre and post-training questionnaire assessed the participants knowledge, confidence and anxiety.
Results
All participants reported orthopaedics as their primary speciality with mean of 6-years experience. 80% reported they are ‘sometimes’ required to scrub for operations in which they do not feel comfortable with the equipment. All participants improved across the 3 unguided sessions reducing their operative time by 47%, assistive prompts by 75%, dominant hand motion by 28% and head motion by 36%. This transferred into the real-world: Participants completed 11.3% of tasks correctly in pre-training compared to 83.5% correct in the timely selection and assembly of rTKA equipment, post-training. All participants reported increased confidence and reduced anxiety after the training.
Conclusion
Unfamiliarity with orthopaedic procedures or equipment is common for scrub nurses and can impact surgical performance. VR training improves their understanding, technical skills and efficiency in complex rTKA. These VR-learnt skills translate into the physical environment. This has important implications on how scrub nurses can be trained remotely, asynchronously and safely to perform complex orthopaedic surgery.
