title: A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy.
abstract: OBJECTIVE
  The aims of this study were to develop virtual reality simulation software for video-assisted thoracic surgery (VATS) lobectomy, to explore the opinions of thoracic surgeons concerning the VATS lobectomy simulator and to test the validity of the simulator metrics.
  
  
  METHODS
  Experienced VATS surgeons worked with computer specialists to develop a VATS lobectomy software for a virtual reality simulator. Thoracic surgeons with different degrees of experience in VATS were enrolled at the 22nd meeting of the European Society of Thoracic Surgeons (ESTS) held in Copenhagen in June 2014. The surgeons were divided according to the number of performed VATS lobectomies: novices (0 VATS lobectomies), intermediates (1-49 VATS lobectomies) and experienced (>50 VATS lobectomies). The participants all performed a lobectomy of a right upper lobe on the simulator and answered a questionnaire regarding content validity. Metrics were compared between the three groups.
  
  
  RESULTS
  We succeeded in developing the first version of a virtual reality VATS lobectomy simulator. A total of 103 thoracic surgeons completed the simulated lobectomy and were distributed as follows: novices n = 32, intermediates n = 45 and experienced n = 26. All groups rated the overall user realism of the VATS lobectomy scenario to a median of 5 on a scale 1-7, with 7 being the best score. The experienced surgeons found the graphics and movements realistic and rated the scenario high in terms of usefulness as a training tool for novice and intermediate experienced thoracic surgeons, but not very useful as a training tool for experienced surgeons. The metric scores were not statistically significant between groups.
  
  
  CONCLUSIONS
  This is the first study to describe a commercially available virtual reality simulator for a VATS lobectomy. More than 100 thoracic surgeons found the simulator realistic, and hence it showed good content validity. However, none of the built-in simulator metrics could significantly distinguish between novice, intermediate experienced and experienced surgeons, and further development of the simulator software is necessary to develop valid metrics.
authors.affiliation: Department of Cardiothoracic Surgery 2152, University Hospital of Copenhagen, Copenhagen, Denmark Centre for Clinical Education (CEKU) 5404, University of Copenhagen and Capital Region, Copenhagen, Denmark katrine.jensen@rh.regionh.dk.
authors.forename: Katrine
authors.initials: K
authors.lastname: Jensen
authors.affiliation: JMC Simulation Unit, The Juliane Marie Centre 4704, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bjerrum
authors.affiliation: Department of Cardiothoracic Surgery 2152, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
authors.affiliation: Department of Cardiothoracic Surgery 2152, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: René Horsleben
authors.initials: RH
authors.lastname: Petersen
authors.affiliation: Department of Cardiothoracic Surgery 2152, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: Jesper Holst
authors.initials: JH
authors.lastname: Pedersen
authors.affiliation: Centre for Clinical Education (CEKU) 5404, University of Copenhagen and Capital Region, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004521:Educational Measurement; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D011013:Pneumonectomy / Q000193:education / Q000379:methods*; D012984:Software; D025321:Surgery, Computer-Assisted / Q000193:education; D020775:Thoracic Surgery, Video-Assisted / Q000193:education / Q000379:methods*; D014584:User-Computer Interface
keywords: Lung cancer; Simulator training; Video-assisted thoracic surgery lobectomy; Virtual reality simulation