Simulation for the video-assisted thoracic surgery surgeon

Video-assisted thoracic surgery (VATS) has emerged since its beginning in 90s to a point where majority of procedures can be performed by a minimally invasive technique. There is an increasing evidence that VATS offer several advantages in many ways, such as patients safety, shorter length of hospitalization, better outcome, decreased trauma and reduced post-operative morbidity compared to thoracotomy. Learning VATS to an efficiency level, where the new generation of thoracic surgeons can operate patients in an operating theatre is a challenging task. To facilitate more rapid learning in a simulated, risk free and time-efficient manner, different type of simulators haven been developed. A search performed in PubMed and Google scholar revealed a total of 454 articles and abstracts were found. One hundred and seventeen articles were duplicates. After review 33 articles were eligible for our study. All the studies showed evidence that simulation has a valuable effect on learning VATS lobectomy. Dry lab and wet-lab simulations offers many opportunities, creates an environment in which novice thoracic surgeons come steps closer to real procedures, but it poses challenges regarding cost, preparation and is time consuming. Virtual Reality on the other hand is more beneficial, because trainees can practice over and over again and they can receive feedback, regarding their movements and progression. There is still a need to develop more software modules for virtual reality VATS simulators, such as removal of all five lobes and simulations simulations of major bleeding from the pulmonary artery. We believe that virtual reality simulation may be the corestone for VATS thoracic training. Simulation training should be implemented as part of VATS training in all centers around the world.