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Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial

Virtual-reality versus black-box simulation



Video-assisted thoracic surgery is gradually replacing conventional open thoracotomy as the method of choice for the treatment of early-stage non-small cell lung cancers, and thoracic surgical trainees must learn and master this technique. Simulation-based training could help trainees overcome the first part of the learning curve, but no virtual-reality simulators for thoracoscopy are commercially available. This study aimed to investigate whether training on a laparoscopic simulator enables trainees to perform a thoracoscopic lobectomy.


Twenty-eight surgical residents were randomized to either virtual-reality training on a nephrectomy module or traditional black-box simulator training. After a retention period they performed a thoracoscopic lobectomy on a porcine model and their performance was scored using a previously validated assessment tool.


The groups did not differ in age or gender. All participants were able to complete the lobectomy. The performance of the black-box group was significantly faster during the test scenario than the virtual-reality group: 26.6 min (SD 6.7 min) versus 32.7 min (SD 7.5 min). No difference existed between the two groups when comparing bleeding and anatomical and non-anatomical errors.


Simulation-based training and targeted instructions enabled the trainees to perform a simulated thoracoscopic lobectomy. Traditional black-box training was more effective than virtual-reality laparoscopy training. Thus, a dedicated simulator for thoracoscopy should be available before establishing systematic virtual-reality training programs for trainees in thoracic surgery.

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Covidien supported the study by providing the staplers free of charge for the test-scenario.


Katrine Jensen, Lars Konge and Charlotte Ringsted have no conflicts of interests to report.

Author information

Correspondence to Katrine Jensen.

Additional information

Henrik Jessen Hansen and René Horsleben Petersen are consultants for Covidien.

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Jensen, K., Ringsted, C., Hansen, H.J. et al. Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial. Surg Endosc 28, 1821–1829 (2014). https://doi.org/10.1007/s00464-013-3392-7

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  • Simulation
  • Thoracoscopy
  • VATS lobectomy
  • Virtual-reality
  • Simulator training