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Virtual-reality Simulation Can Teach Vats Lobectomy To Lobectomy-na¤Ve Trainees Within 4 Weeks: A Cross-over Study
Jeremy Chan1, Bijendra Patel2, Artemis Mantzavinou1, Ashwin Gojanur2, Sri Subramaniam3, Kelvin Lau4.
1Barts and the London School of Medicine and Dentistry, London, United Kingdom, 2Barts Cancer Institute, London, United Kingdom, 3Medtronic Limited, Watford, United Kingdom, 4Barts Thorax Centre, St Bartholomew's Hospital, London, United Kingdom.

BACKGROUND: The aim of the cross-over study was to evaluate skill acquisition in lobectomy-naive surgical trainees completing a 4-week program to learn VATS lobectomy on a virtual reality surgical simulator (LapSim).
METHODS: Lobectomy-na´ve surgical trainees (year 1 and 2 postgraduation) were enrolled during the COVID pandemic from March to June 2021 for a 4-week course on basic VATS skills and right upper lobectomy. They were divided into 2 groups. Both groups completed an initial assessment, Group 1 completed the course first, then both groups completed a second assessment. Then Group 2 completed the course, and both groups completed a final assessment. Skill acquisition was assessed using instrument movement, procedure time, and blood loss for both the trained operation and an untrained operation (left lower lobectomy).
RESULTS: 16 trainees were enrolled, 10 completed the training program. There was no difference in baseline assessment. After Group 1 completed the training, they outperformed Group 2 in all metrics but this did not reach statistical significance. After training Group 2 at week 8, there was no longer difference in performance from Group 1. After completing the training program, the entire cohort showed a significant improvement in basic VATS tasks as well as lobectomies. There was statistically significant improvement in both right upper lobectomy instrument movement (p=0.002) and time (p=0.009) and left lower lobectomy time (p=0.047).
CONCLUSIONS: This study showed that VATS simulation training on LapSim allowed junior trainees to learn advanced VATS resection during a pandemic and within 4 weeks.The acquired skills is transferrable to untrained operations.

Trainee performance before and after the VATS lobectomy course
Total cohort median before courseTotal cohort median after coursep value
Trained right upper lobectomy instrument movement (m)45.726.10.022
Trained right upper lobectomy procedure time (s)1171.54630.009
Trained right upper lobectomy blood loss (ml)255.5256.50.721
Untrained left lower lobectomy instrument movement (m)60.935.70.093
Untrained lower left lobectomy procedure time (s)1665.57980.047
Untrained lower left lobectomy blood loss (ml)

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