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. 2017 Jun;31(6):2520-2528.
doi: 10.1007/s00464-016-5254-6. Epub 2016 Sep 21.

Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy

Katrine Jensen  1   2 , Flemming Bjerrum  3 , Henrik Jessen Hansen  4 , René Horsleben Petersen  4 , Jesper Holst Pedersen  4 , Lars Konge  5
Affiliations

Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy

Katrine Jensen et al. Surg Endosc. 2017 Jun.

Abstract

Background: The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe.

Methods: Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim®) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded.

Results: Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives).

Conclusion: This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.

Keywords: Lobectomy; VATS; Validity; Video-assisted thoracoscopic surgery; Virtual reality simulation.

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