Future strategy of surgical simulations in video-assisted thoracic surgery

Video-assisted thoracic surgery (VATS) has come to be the primary operative procedure in thoracic surgery as the method of choice for the treatment of a variety of lung diseases. As VATS has acquired widespread favor with the development of techniques and instrumentation, indications for VATS have further expanded. However, many facilities have yet to adopt this approach for anatomical lung resections. In terms of building VATS educational platforms, standardization of the training programs that is based on risk-free based teaching strategies is essential. Today, surgical simulations have a pivotal role in increased patient safety and reduction of the risk of surgical errors as a desired part of the training model for not only residents but also consultants who need to acquire new techniques. There are two different categories of surgeons requiring skills of thoracoscopic procedure who must be considered: (I) surgeons who had experienced a period of transition from open thoracotomy to VATS, and (II) the new generation of surgeons being trained after the exponential development of VATS. The evolution of simulation programs such as cadavers, live animals, black-boxes, and three-dimensional virtual reality simulators can compensate for their limited-operating room-based training opportunities and aid them in the acquisition of necessary skills in a brief time. We will discuss the types of simulators focusing on the desired programs to allow the new generation of surgeons to master VATS lobectomy with a shorted learning curve and a future strategy of surgical simulations in VATS.