A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus

Category: Bunion Introduction/Purpose: Minimally Invasive Surgery (MIS) for Hallux Valgus (HV) has become popular with similar results as open surgery with added benefits such as lower post-operative opioid use and improved cosmesis. However, adopting this technique faces challenges due to a pronounced learning curve. This study aims to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. Methods: A training program and a simulation model for HV MIS were designed based on recommendations from three experts. The phantoms were created using computed tomography scans of a patient with mild HV deformity, with iterative refinement through 3D printing and testing. Four experts performed a satisfaction survey of the phantoms. Participants, categorized into two groups based on MIS experience, underwent blind assessments. Evaluation parameters, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and X-ray usage. Four orthopedic surgeons without MIS experience took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery and a program evaluation survey. Four foot and ankle surgeons with vast experience performed the same procedure with one simulated model in order to compare the two groups' initial performance.The desired performance for novices was set at 80% of experts' performance for OSATS score. Results: Expert evaluation of the phantoms indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range 23-25) vs. 15.5 (range 12-17) (p=.01), median surgical times of 22.75 minutes (range 12-27) vs. 48.75 minutes (38-60) (p=.02), and median X-ray usage of 70 (range 53-102) vs. 232.5 (range 112-280) (p=.02). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (p = .01), reaching the desired performance of 20 points. Performance at the final training with the phantom did not differ from cadaveric surgery outcomes for all parameters. All trained novices expressed high satisfaction regarding the training program and reported that this program effectively enhanced their surgical skills and confidence. Conclusion: This study validated a simulation phantom model and training program, allowing non-experienced HV MIS orthopedic foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaveric model. [Figure: see text]