Knee surgeon arthroscopic skills training has advanced considerably in the last 20 years. It is no longer valid for trainee surgeons to have to develop their manual skills on live patients albeit under the supervision of a senior colleague.
When keyhole surgery first came into widespread practice in the late 1980s, surgeons were faced with the challenge of having to develop new manual and three-dimensional co-ordination skills, and workshops sprang up in training centres around the world to cater for this need. Manufactured training models allowed the surgeon to learn adequate arthroscopic navigation and basic surgical techniques, but could not offer the degree of realism of live surgery. Animal ‘models’, such as prepared pig knee, offered more realism and the important matters of inflating the joint with irrigation fluid and maintaining the fluid pressure sufficient to allow the anatomical structures to be clearly appreciated. Managing this irrigation is part of the skill set that the arthroscopic surgeon has to master, but there are often ethical or religious reasons for a surgeon not to want to handle animal tissues.
Skills trainers then looked towards using human cadaveric models. Special skills laboratories were developed where donated human knees were available, attached to special clamps to allow the surgeon to manipulate the joint as he/she would on a live patient. This is really as good as it gets. Although there is no bleeding of the tissues, that does not matter much as many surgeons use tourniquets around the thighs anyway to stop blood flow completely to the lower limb during surgery.
The cadaver knees are, of course, available by the generosity of donors who have died and the ‘specimens’ are managed by specialist companies who prepare them and freeze them for storage. They can then be thawed and available when needed. The same organisation will arrange for the knees to be respectfully and properly disposed of after the workshop has concluded.
Arranging to go to a cadaver lab, however, involves the surgeon’s time and expense and the hospital will lose revenue while he/she is away. When the whole surgical team need to become familiar with a particular new procedure, it is a very costly matter to take both the surgeon and the operating assistants to such a lab.
The company, Arthrex, who already run a cadaver lab in Munich where there are 12 operating ‘workstations’, have invested in a neat solution. They have kitted out a mobile surgical skills lab which can be driven around Europe and the UK, allowing surgical teams to use the lab close to their normal workplace.
The lab has two fully equipped arthroscopic workstations, with full irrigation facilities and instrumentation, and a third workstation that is available for ‘open’ procedures where the arthroscope and irrigation are not used.
The mobile unit has a system for the disposal of the waste water and also a system for fully disinfecting the lab environment and the equipment at the end of the session. Surgeons can glove and gown, and put on the usual waterproof boots that they don during arthroscopy. The operating environment is an almost perfect simulation of the real thing in a hospital operating room.
Joints other than knees can also be used for training, such as the shoulder
Although the mobile lab costs hundreds of thousands of £ to maintain, this cost is offset by the huge saving that each separate hospital makes in not having to lose their surgical team while they travel to a distant training facility.
This paper was not supported by any financial contribution from Arthrex or any other individual or organisation. The author visited the unit during the BASK meeting in Leeds in 2013. If anyone is interested in more information, they should contact Tobias Brunner, Lab Service or Teri Blythe, UK Special Projects Manager, both of Arthrex.