title: Training in minimally invasive lobectomy: thoracoscopic versus robotic approaches.
abstract: BACKGROUND
  Skills required for thoracoscopic and robotic operations likely differ. The needs and abilities of trainees learning these approaches require assessment.
  
  
  METHODS
  Trainees performed initial components of minimally invasive lobectomies using thoracoscopic or robotic approaches. Component difficulty was scored by trainees using the NASA task load index (NASATLX). Performance of each component was graded by trainees and attending surgeons on a 5-point ordinal scale (naïve, beginning learner, advanced learner, competent, master).
  
  
  RESULTS
  Eleven surgical trainees performed 87 replications among three lobectomy components (divide pulmonary ligament; dissect level 7/8/9 nodes; dissect level 4/5 nodes). Before performance NASATLX scores did not differ among components or between surgical approaches. Trainees' after performance NASATLX scores appropriately calibrated task load for the components. After performance NASATLX scores were significantly lower for thoracoscopy than before performance estimates; robotic scores were similar before surgery and after performance. Task load was higher for robotic than for thoracoscopic approaches. Trainees rated their performance higher than did attending surgeons in domains of knowledge and thinking, but ratings for other domains were similarly low. Ratings for performance improved significantly as component performance repetitions increased.
  
  
  CONCLUSIONS
  Trainees did not differentiate task load among components or surgical approaches before attempting them. Task load scores differentiated difficulty among initial components of lobectomy, and were greater for robotic than for thoracoscopic approaches. Trainees overestimated their level of cognitive performance compared with attending physician evaluation of trainee performance. The study provides insights into how to customize training for thoracoscopic and robotic lobectomy and identifies tools to assess training effectiveness.
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: mferguso@surgery.bsd.uchicago.edu.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Cindy
authors.initials: C
authors.lastname: Warnes
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Celauro
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Wickii T
authors.initials: WT
authors.lastname: Vigneswaran
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Prachand
mesh_terms: D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D010865:Pilot Projects; D011013:Pneumonectomy / Q000193:education*; D011446:Prospective Studies; D012371:Robotics / Q000193:education*; D020775:Thoracic Surgery, Video-Assisted / Q000193:education*