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Published in: Surgical Endoscopy 6/2017

01-06-2017

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

Authors: Katrine Jensen, Flemming Bjerrum, Henrik Jessen Hansen, René Horsleben Petersen, Jesper Holst Pedersen, Lars Konge

Published in: Surgical Endoscopy | Issue 6/2017

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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.
Literature
2.
go back to reference Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BBK (2011) A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg 142:496–503. doi:10.1016/j.jtcvs.2011.05.015 CrossRefPubMed Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BBK (2011) A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg 142:496–503. doi:10.​1016/​j.​jtcvs.​2011.​05.​015 CrossRefPubMed
4.
go back to reference Crochet P, Aggarwal R, Dubb SS, Ziprin P, Rajaretnam N, Grantcharov T, Ericsson KA, Darzi A (2011) Deliberate practice on a virtual reality laparoscopic simulator enhances the quality of surgical technical skills. Ann Surg 253:1216–1222. doi:10.1097/SLA.0b013e3182197016 CrossRefPubMed Crochet P, Aggarwal R, Dubb SS, Ziprin P, Rajaretnam N, Grantcharov T, Ericsson KA, Darzi A (2011) Deliberate practice on a virtual reality laparoscopic simulator enhances the quality of surgical technical skills. Ann Surg 253:1216–1222. doi:10.​1097/​SLA.​0b013e3182197016​ CrossRefPubMed
6.
go back to reference Schijven MP, Jakimowicz JJ, Broeders IAMJ, Tseng LNL (2005) The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum. Surg Endosc Other Interv Tech 19:1220–1226. doi:10.1007/s00464-004-2240-1 CrossRef Schijven MP, Jakimowicz JJ, Broeders IAMJ, Tseng LNL (2005) The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum. Surg Endosc Other Interv Tech 19:1220–1226. doi:10.​1007/​s00464-004-2240-1 CrossRef
7.
go back to reference Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L (2015) A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg 21:420–426. doi:10.1093/icvts/ivv183 CrossRefPubMed Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L (2015) A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg 21:420–426. doi:10.​1093/​icvts/​ivv183 CrossRefPubMed
9.
go back to reference Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L (2014) Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc Other Interv Tech 28:1821–1829. doi:10.1007/s00464-013-3392-7 CrossRef Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L (2014) Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc Other Interv Tech 28:1821–1829. doi:10.​1007/​s00464-013-3392-7 CrossRef
10.
go back to reference Bjerrum F, Sorensen JL, Konge L, Rosthøj S, Lindschou J, Ottesen B, Strandbygaard J (2016) Randomized clinical trial to examine procedure-to-procedure transfer in laparoscopic simulator training. Br J Surg 103:44–50. doi:10.1002/bjs.9966 CrossRefPubMed Bjerrum F, Sorensen JL, Konge L, Rosthøj S, Lindschou J, Ottesen B, Strandbygaard J (2016) Randomized clinical trial to examine procedure-to-procedure transfer in laparoscopic simulator training. Br J Surg 103:44–50. doi:10.​1002/​bjs.​9966 CrossRefPubMed
20.
go back to reference Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191:272–283. doi:10.1016/S1072-7515(00)00339-2 CrossRefPubMed Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191:272–283. doi:10.​1016/​S1072-7515(00)00339-2 CrossRefPubMed
24.
go back to reference Lee R, Enter D, Lou X, Feins RH, Hicks GL, Gasparri M, Takayama H, Young JN, Calhoon JH, Crawford FA, Mokadam NA, Fann JI (2013) The joint council on thoracic surgery education coronary artery assessment tool has high interrater reliability. Ann Thorac Surg 95:2064–2070. doi:10.1016/j.athoracsur.2012.10.090 CrossRefPubMed Lee R, Enter D, Lou X, Feins RH, Hicks GL, Gasparri M, Takayama H, Young JN, Calhoon JH, Crawford FA, Mokadam NA, Fann JI (2013) The joint council on thoracic surgery education coronary artery assessment tool has high interrater reliability. Ann Thorac Surg 95:2064–2070. doi:10.​1016/​j.​athoracsur.​2012.​10.​090 CrossRefPubMed
28.
go back to reference Hansen HJ, Petersen RH, Christensen M (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg Endosc Other Interv Tech 25:1263–1269. doi:10.1007/s00464-010-1355-9 CrossRef Hansen HJ, Petersen RH, Christensen M (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg Endosc Other Interv Tech 25:1263–1269. doi:10.​1007/​s00464-010-1355-9 CrossRef
30.
go back to reference Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sørensen JL, Dalsgaard T, Ottesen B (2006) Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc 20:1460–1466. doi:10.1007/s00464-005-0745-x CrossRefPubMed Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sørensen JL, Dalsgaard T, Ottesen B (2006) Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc 20:1460–1466. doi:10.​1007/​s00464-005-0745-x CrossRefPubMed
31.
go back to reference Van Dongen KW, Tournoij E, Van Der Zee DC, Schijven MP, Broeders IAMJ (2007) Construct validity of the LapSim: Can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc Other Interv Tech 21:1413–1417. doi:10.1007/s00464-006-9188-2 CrossRef Van Dongen KW, Tournoij E, Van Der Zee DC, Schijven MP, Broeders IAMJ (2007) Construct validity of the LapSim: Can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc Other Interv Tech 21:1413–1417. doi:10.​1007/​s00464-006-9188-2 CrossRef
34.
go back to reference Vassiliou MC, Ghitulescu GA, Feldman LS, Stanbridge D, Leffondré K, Sigman HH, Fried GM (2006) The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endosc Other Interv Tech 20:744–747. doi:10.1007/s00464-005-3008-y CrossRef Vassiliou MC, Ghitulescu GA, Feldman LS, Stanbridge D, Leffondré K, Sigman HH, Fried GM (2006) The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endosc Other Interv Tech 20:744–747. doi:10.​1007/​s00464-005-3008-y CrossRef
36.
go back to reference Rivard JD, Vergis AS, Unger BJ, Hardy KM, Andrew CG, Gillman LM, Park J (2014) Construct validity of individual and summary performance metrics associated with a computer-based laparoscopic simulator. Surg Endosc Other Interv Tech 28:1921–1928. doi:10.1007/s00464-013-3414-5 CrossRef Rivard JD, Vergis AS, Unger BJ, Hardy KM, Andrew CG, Gillman LM, Park J (2014) Construct validity of individual and summary performance metrics associated with a computer-based laparoscopic simulator. Surg Endosc Other Interv Tech 28:1921–1928. doi:10.​1007/​s00464-013-3414-5 CrossRef
41.
go back to reference Loukas C, Nikiteas N, Schizas D, Lahanas V, Georgiou E (2012) A head-to-head comparison between virtual reality and physical reality simulation training for basic skills acquisition. Surg Endosc 26:2550–2558. doi:10.1007/s00464-012-2230-7 CrossRefPubMed Loukas C, Nikiteas N, Schizas D, Lahanas V, Georgiou E (2012) A head-to-head comparison between virtual reality and physical reality simulation training for basic skills acquisition. Surg Endosc 26:2550–2558. doi:10.​1007/​s00464-012-2230-7 CrossRefPubMed
42.
go back to reference Zendejas B, Ruparel RK, Cook DA (2015) Validity evidence for the fundamentals of laparoscopic surgery (FLS) program as an assessment tool: a systematic review. Surg Endosc Other Interv Tech 30:512–520. doi:10.1007/s00464-015-4233-7 CrossRef Zendejas B, Ruparel RK, Cook DA (2015) Validity evidence for the fundamentals of laparoscopic surgery (FLS) program as an assessment tool: a systematic review. Surg Endosc Other Interv Tech 30:512–520. doi:10.​1007/​s00464-015-4233-7 CrossRef
50.
go back to reference Savran MM, Hansen HJ, Petersen RH, Walker W, Schmid T, Bojsen SR, Konge L (2015) Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 29:2598–2604. doi:10.1007/s00464-014-3975-y CrossRefPubMed Savran MM, Hansen HJ, Petersen RH, Walker W, Schmid T, Bojsen SR, Konge L (2015) Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 29:2598–2604. doi:10.​1007/​s00464-014-3975-y CrossRefPubMed
51.
go back to reference Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT (2015) Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of gastrointestinal endoscopy (ESGE) guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of thor. Eur J Cardiothorac Surg 48:1–15. doi:10.1093/ejcts/ezv194 CrossRefPubMed Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT (2015) Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of gastrointestinal endoscopy (ESGE) guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of thor. Eur J Cardiothorac Surg 48:1–15. doi:10.​1093/​ejcts/​ezv194 CrossRefPubMed
52.
go back to reference Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A, Reznick R (2010) Training and simulation for patient safety. Qual Saf Health Care 19(Suppl 2):i34–i43. doi:10.1136/qshc.2009.038562 CrossRefPubMed Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A, Reznick R (2010) Training and simulation for patient safety. Qual Saf Health Care 19(Suppl 2):i34–i43. doi:10.​1136/​qshc.​2009.​038562 CrossRefPubMed
55.
go back to reference Konge L, Vilmann P, Clementsen P, Annema JT, Ringsted C (2012) Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer. Endoscopy 44:928–933. doi:10.1055/s-0032-1309892 CrossRefPubMed Konge L, Vilmann P, Clementsen P, Annema JT, Ringsted C (2012) Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer. Endoscopy 44:928–933. doi:10.​1055/​s-0032-1309892 CrossRefPubMed
Metadata
Title
Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy
Authors
Katrine Jensen
Flemming Bjerrum
Henrik Jessen Hansen
René Horsleben Petersen
Jesper Holst Pedersen
Lars Konge
Publication date
01-06-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5254-6

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