Training of video-assisted thoracoscopic surgery lobectomy: the role of simulators

Traditionally, trainees in thoracic surgery acquire their surgical skills in the operating room while being assisted or supervised by an experienced thoracic surgeon during open procedures. In video-assisted thoracoscopic surgery (VATS) however, only few instruments can be used at the same time which makes assisting and teaching during the procedure more difficult. Therefore, the trainee should already have basic competence in core VATS skills to perform the procedure efficiently and safely. Examples of these skills are: hand-eye coordination, manual dexterity, depth perception, interaction of the dominant and non-dominant hand as well as technical skills like grasping, retraction and exposure, dissection and use of energy devices, use of endoscopic stapling devices and division of major vessels. In this setting VATS simulators can be an excellent tool to practice core VATS skills safely and effectively. Those skills can then be applied in the operating room during real procedures.