Article Abstract

Virtual simulation and learning new skills in video-assisted thoracic surgery

Authors: Benedetta Bedetti, Luca Bertolaccini, Davide Patrini, Joachim Schmidt, Marco Scarci


Background: The effectiveness of training video-assisted thoracic surgery (VATS) resident surgeons using virtual reality (VR) simulation is stated in many studies, however its use is still not established in the normal practice. The purpose of this study is to create a VR curriculum to offer an evidence-based approach for VATS training programs.
Methods: Skills were evaluated with two tests: Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Thoracoscopic Skills (GOATS). Surgeons were evaluated for cognitive workload according to National Aeronautics Space Administration-Task Load Index (NASA-TLX). Subjects were stratified into two groups: trainees and consultants. Differences in performance between groups were analyzed using the Kruskal-Wallis test for nonparametric data.
Results: In total 20 voluntaries completed all tasks (trainees =12, consultant =8). Comparisons between trainee and consultant groups showed similar results in all tests on P values. OSATS and GOATS performance of both groups were similar without skills differences regarding experience. Median scores of experienced surgeons were taken as benchmark levels. Comparison of the novices’ scores with benchmark levels showed that all were able to achieve the set criteria. The Kiviat diagram of the NASA-TLX cognitive workload assessment proved a greater mental and physical demand in the trainees. Nevertheless, these variations between groups were not significantly different.
Conclusions: VR training can shorten the learning curve, even if is not designed to replace the experience gained in the operating theatre. A VATS training curriculum with VR assessment allows trainees to get acquainted, train and learn the VATS lobectomy technique. This study supports clearly the inclusion of VR simulation into surgical training programs.