RNOH Trial

A few weeks back I saw an opportunity advertised by the medical school bulletin that allowed medical students to be a part of a simulator trial at the Royal National Orthopaedic Hospital. Although I have had previous experience of using simulator robots, I have never had the experience of being a part of a trial, therefore I decided to sign up.

The trial involved attending two, one hour sessions at the training centre in Stanmore and within each hour there were two tasks set to complete. Both tasks involved drilling a guide wire into the femur so that it ends up positioned in the middle of the apex of the femur. The aim of procedures like this are to stabilise fractures between the trochanters in the femur. The two tasks had the same principle but varied in method: i) done through a simulator robot ii) done through the use of a surgical drill and styrofoam model.

With no previous experience or insight into the orthopaedic field I was really nervous; especially considering the fact that I was being scored on my performance. Nonetheless, I took on the challenge and with hindsight I must say I thoroughly enjoyed it.

Robot SimulatorThe simulator robot arm used to navigate the drill on screen was very sensitive. In order to execute the angle at which I was going to insert the drill into the femur, I had to be very careful in the way I was moving the robot arm, hence requiring a very strong hand-eye co-ordination. The aim was to get the drill and the guide in a position which can ensure that within one drill, the hole is made directly to the middle of the apex of the femur. Ideally, the less holes in the patient’s femur the better as it avoids causing the patient pain. In order to aid the process of drilling, a lateral and anterior-posterior x-ray film could be taken. On my first attempt, it took me around 10 to 15 minutes of constant slight movements with a very stiff arm along with 150 x-rays to get the drill in what looked like the right position. Unfortunately, on my first go I had underestimated the angle which resulted in a score of 2/11. But on my second attempt I was much closer to the ideal position and managed to secure a score of 9.93/11.

In the second task, the same concept and features applied, however this time I was physically doing the procedure with an actual drill and polystyrene model (this was acting as the patient’s femur). On one hand I had the guide (metal piece) positioned along the model and on the other I had the drill with the wire inserted into it. I faced two challenges. One involved actually being able to hold the very heavy drill in a steady position so that I could ensure the wire was going in horizontally. And second, as it was just a polystyrene block and not a femur model, it was not easy to pinpoint the shaft of the femur in order to get a good sense of direction and indication of where to insert the drill therefore, just as with the simulator, I had to rely on the x-ray films. However, in terms of coordination it was much easier as I was physically in control of the drill therefore it was much easier to navigate.

AP and Lateral X-rays

In my opinion, I felt that if surgeons are able to practice their surgical skills both on simulation systems and models, it would aid their training. Also, considering the medical field is becoming much more modern and innovative in terms of technology, who knows, maybe one day all our surgeries will be done through robots, therefore it is great if surgeons are exposed to training which involves this simulation experience.

Overall, it was a fantastic experience. Considering it was both my first trial and first exposure to orthopaedics, I was somewhat pleased with my results. Although I do still need a lot of practice! Nonetheless, the opportunity to conduct an orthopaedic procedure but also to trial a new simulator robot was totally worth it.

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