Can a Low-Fidelity Arthroscopic Simulator Improve Technical Expertise in Performing Temporomandibular Joint Arthroscopy?

Background: Challenges in temporomandibular joint (TMJ) arthroscopy training include the cost of operating room time, surgical risks, and the accessibility of cadavers and high-fidelity simulators. A low-fidelity simulator (LFS) was developed for initial TMJ arthroscopy training.

Purpose: The aim of this study was to evaluate improvement in TMJ arthroscopic skills after training with an LFS using the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale.

Study Design, Setting, Sample: A prospective randomized controlled study was conducted. Subjects included Oral and Maxillofacial Surgery residents in postgraduate year 1-5 at Thomas Jefferson University. Chief residents actively performing TMJ arthroscopy were excluded.

Predictor Variable: The predictor variable was participation in LFS training. Subjects were randomly assigned to the LFS training or no LFS training group.

Main Outcome Variables: The primary outcome variable was simulated surgical skill measured by total ASSET score (maximum score of 35). The secondary outcome variables were simulated surgical skill measured by each ASSET domain score and time to completion.

Covariates: The covariates included sex, age, handedness, postgraduate year, endoscopic experience, open TMJ surgery experience, and experience with musical instruments and sports.

Analyses: Data analyses included paired T-tests to determine changes in outcome variables after TMJ arthroscopy training between experimental groups, and ANOVA and χ tests to identify associations between covariates. Inter-rater reliability of the blinded examiners was evaluated using Cronbach's alpha correlation. A P-value < .05 was considered significant.

Results: The sample was composed of 10 residents: 5 (100%) males in the no LFS group, 3 (60%) males, and 2 (40%) females in the LFS group (P = .4). There was no significant difference between the groups in pre-TMJ arthroscopy training ASSET scores (P = .3). After training, the total ASSET score improved by 3.40 ± 6.87 in the no LFS group and by 6.27 ± 2.68 in the LFS group (P = .03).

Conclusions And Relevance: Study results showed that low-fidelity simulation can improve fundamental arthroscopic skills. Future research should be conducted on a larger scale to further validate this model and show the transfer of skill improvements to cadaver and live patient settings.