Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST)

Tatjana Pastor; Jan Buschbaum; Mathilde von Laue; Björn Christian Link; Frank J. P. Beeres; James Fletcher; Bergita Ganse; R. Geoff Richards; Boyko Gueorguiev; Torsten Pastor

doi:10.1007/s00068-024-02686-6

Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST)

Tatjana Pastor, Jan Buschbaum, Mathilde von Laue, Björn Christian Link, Frank J. P. Beeres, James Fletcher, Bergita Ganse, R. Geoff Richards, Boyko Gueorguiev, Torsten Pastor

Department for Health

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Digitally Enhanced Hands-on Surgical Training (DEHST) platform was introduced to overcome the lack of training capabilities for the challenging task of freehand distal interlocking of intramedullary nails. It demonstrates high perceived realism for surgeons, and novices perform significantly better after DEHST training. However, characterization of how performance improves remained unexplored. The aim of this study was to evaluate the training progression of novices in freehand distal interlocking during five training rounds with DEHST and to compare their performance in a simulated operation against experienced surgeons.

METHODS: Ten novices (Group 1) underwent five DEHST training sessions (approximately one hour in total) and their performance data was acquired and evaluated. The surgical performance of Group 1 was compared with ten surgical experts (Group 2) by performing distal interlocking of a real tibia nail in an artificial bone model in a simulated operation. Time taken, number of X-rays, accuracy of nail hole roundness, and success rates were compared between the groups.

RESULTS: Group 1 achieved comparable performance to Group 2 in number of X-rays 26.0 (range 15-40) versus 22.5 (range 16-34), p = 0.281, and accuracy of hole roundness 95.0% (range 91.1-98.0%) versus 93.3% (range 90.7-95.9%), p = 0.087. However, Group 1 needed significantly longer time compared with Group 2, p = 0.001, and furthermore, one participant in Group 1 (10%) failed to hit the nail hole with the drill bit, while 100% of the participants in Group 2 were successful.

CONCLUSIONS: DEHST appears to be a useful tool to gradually improve the proficiency level of novices and to train relevant practical surgical skills needed for distal interlocking of intramedullary nails. However, further investigations are needed to demonstrate the performance under the conditions of a real operation.

Original language	English
Article number	7
Journal	European Journal of Trauma and Emergency Surgery
Volume	51
Issue number	1
Early online date	11 Jan 2025
DOIs	https://doi.org/10.1007/s00068-024-02686-6
Publication status	Published - 11 Jan 2025

Data Availability Statement

No datasets were generated or analysed during the current study.

Keywords

Distal interlocking
Education
Intramedullary nailing
Simulation
Training

ASJC Scopus subject areas

Surgery
Emergency Medicine
Orthopedics and Sports Medicine
Critical Care and Intensive Care Medicine

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10.1007/s00068-024-02686-6

Cite this

Pastor, T., Buschbaum, J., von Laue, M., Link, B. C., Beeres, F. J. P., Fletcher, J., Ganse, B., Richards, R. G., Gueorguiev, B., & Pastor, T. (2025). Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST). European Journal of Trauma and Emergency Surgery , 51(1), Article 7. https://doi.org/10.1007/s00068-024-02686-6

Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST). / Pastor, Tatjana; Buschbaum, Jan; von Laue, Mathilde et al.
In: European Journal of Trauma and Emergency Surgery , Vol. 51, No. 1, 7, 11.01.2025.

Research output: Contribution to journal › Article › peer-review

Pastor, T, Buschbaum, J, von Laue, M, Link, BC, Beeres, FJP, Fletcher, J, Ganse, B, Richards, RG, Gueorguiev, B & Pastor, T 2025, 'Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST)', European Journal of Trauma and Emergency Surgery , vol. 51, no. 1, 7. https://doi.org/10.1007/s00068-024-02686-6

Pastor T, Buschbaum J, von Laue M, Link BC, Beeres FJP, Fletcher J et al. Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST). European Journal of Trauma and Emergency Surgery . 2025 Jan 11;51(1):7. Epub 2025 Jan 11. doi: 10.1007/s00068-024-02686-6

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abstract = "BACKGROUND: Digitally Enhanced Hands-on Surgical Training (DEHST) platform was introduced to overcome the lack of training capabilities for the challenging task of freehand distal interlocking of intramedullary nails. It demonstrates high perceived realism for surgeons, and novices perform significantly better after DEHST training. However, characterization of how performance improves remained unexplored. The aim of this study was to evaluate the training progression of novices in freehand distal interlocking during five training rounds with DEHST and to compare their performance in a simulated operation against experienced surgeons. METHODS: Ten novices (Group 1) underwent five DEHST training sessions (approximately one hour in total) and their performance data was acquired and evaluated. The surgical performance of Group 1 was compared with ten surgical experts (Group 2) by performing distal interlocking of a real tibia nail in an artificial bone model in a simulated operation. Time taken, number of X-rays, accuracy of nail hole roundness, and success rates were compared between the groups. RESULTS: Group 1 achieved comparable performance to Group 2 in number of X-rays 26.0 (range 15-40) versus 22.5 (range 16-34), p = 0.281, and accuracy of hole roundness 95.0% (range 91.1-98.0%) versus 93.3% (range 90.7-95.9%), p = 0.087. However, Group 1 needed significantly longer time compared with Group 2, p = 0.001, and furthermore, one participant in Group 1 (10%) failed to hit the nail hole with the drill bit, while 100% of the participants in Group 2 were successful. CONCLUSIONS: DEHST appears to be a useful tool to gradually improve the proficiency level of novices and to train relevant practical surgical skills needed for distal interlocking of intramedullary nails. However, further investigations are needed to demonstrate the performance under the conditions of a real operation.",

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AU - Link, Björn Christian

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AB - BACKGROUND: Digitally Enhanced Hands-on Surgical Training (DEHST) platform was introduced to overcome the lack of training capabilities for the challenging task of freehand distal interlocking of intramedullary nails. It demonstrates high perceived realism for surgeons, and novices perform significantly better after DEHST training. However, characterization of how performance improves remained unexplored. The aim of this study was to evaluate the training progression of novices in freehand distal interlocking during five training rounds with DEHST and to compare their performance in a simulated operation against experienced surgeons. METHODS: Ten novices (Group 1) underwent five DEHST training sessions (approximately one hour in total) and their performance data was acquired and evaluated. The surgical performance of Group 1 was compared with ten surgical experts (Group 2) by performing distal interlocking of a real tibia nail in an artificial bone model in a simulated operation. Time taken, number of X-rays, accuracy of nail hole roundness, and success rates were compared between the groups. RESULTS: Group 1 achieved comparable performance to Group 2 in number of X-rays 26.0 (range 15-40) versus 22.5 (range 16-34), p = 0.281, and accuracy of hole roundness 95.0% (range 91.1-98.0%) versus 93.3% (range 90.7-95.9%), p = 0.087. However, Group 1 needed significantly longer time compared with Group 2, p = 0.001, and furthermore, one participant in Group 1 (10%) failed to hit the nail hole with the drill bit, while 100% of the participants in Group 2 were successful. CONCLUSIONS: DEHST appears to be a useful tool to gradually improve the proficiency level of novices and to train relevant practical surgical skills needed for distal interlocking of intramedullary nails. However, further investigations are needed to demonstrate the performance under the conditions of a real operation.

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Assessment of the proficiency level of novices in distal intramedullary nail interlocking achieved through training with Digitally Enhanced Hands-on Surgical Training (DEHST)

Abstract

Data Availability Statement

Keywords

ASJC Scopus subject areas

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