Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Thoraxkirurgisk afd. 2152, Blegdamsvej 9, 2100, Copenhagen, Denmark, katrine.jensen@regionh.dk.
Katrine
K
Jensen
Charlotte
C
Ringsted
Henrik Jessen
HJ
Hansen
René Horsleben
RH
Petersen
Lars
L
Konge
D000328:Adult; D000818:Animals; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D059032:Learning Curve; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000193:education*; D013906:Thoracoscopy / Q000193:education*; D014584:User-Computer Interface