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.
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
- VATS lobectomy
- Simulator training