Validation of a training simulator for temporomandibular joint arthroscopy

This study aims to evaluate a temporomandibular joint (TMJ) arthroscopy simulator using construct and face analyses.

Thirty participants attending a TMJ training course were divided into novice and expert surgeons (more than 100 procedures) and performed two arthroscopic tasks (cavity access/cavity exploration) during which the surgical tool movements were tracked. Five objective metrics were used to measure surgeon ability and construct validity was assessed by comparing novel and expert performance. Face validity was assessed by subjective questionnaires rating simulator realism and utility (1-5 scale) and tissue consistency (1-4 scale).

Expert surgeons spent less total time (76.58 ± 47.40 vs. 27.60 ± 5.52; novices vs. experts) with higher average speed (7.40 ± 5.32 vs. 12.65 ± 5.37) and average acceleration (198.33 ± 2.42 vs. 325.93 ± 87.36). Movement smoothness revealed lower values in novice surgeons (3638.33 ± 1083.95 mm/s³; 2553.70 ± 768.01 mm/s³) than in expert surgeons (4655.63 ± 837.05 mm/s³; 4172.08 ± 1098.61 mm/s³). All these outcomes reached statistical significance (p ≤ 0.05) but in contrast total path of the instruments did not. Face validity scores averaged 4.75/5 for utility and over 4/5 for realism except for watertightness. Tissue consistency was regarded as lower than human tissue but without impact on the training experience. There were no statistically significant differences between the two groups.

Both the construct and face validity analyses confirmed the TMJ simulator can be regarded as a valuable, safe, economic adjunctive tool to train TMJ arthroscopy.