Training and precision surgery in VATS lobectomy

Learning and mastering video-assisted thoracoscopic surgery (VATS) is complicated and ensuring that all trainees reach a level where they can operate independently and proficient requires extensive knowledge regarding training and certification methods. We reviewed the literature regarding training in VATS lobectomy in order to evaluate the evidence and discuss the different programs in teaching VATS lobectomy, the learning curve, the role of simulation, and the role of certification and assessment in VATS lobectomy. A search performed in PubMed from their commencement to February 2019, identified 335 articles and abstracts. After reviewing all these articles, 30 articles were eligible for full text screening. We conclude that there is a need for a structured VATS lobectomy training program in every institution handling lung cancer patients. Stepwise learning where trainees prepare theoretically followed by off theatre preparation, such as learning the basic skills using virtual reality simulation and dry and wet lab simulation is essential. Once the basic skills are learned, the novice surgeons can perform minor VATS procedures and gradually perform lobectomies under supervision until reaching competency and precision in VATS lobectomy. We suggest that VATS programs should be completed with certification.