VATS Simulator Project
Prof. Vinesh Raja (WMG), Prof. Babu Naidu (Heart of England Regional Thoracic
Surgery Department) and Tracey Starkey-Moore (Hollier Medical Simulation Centre)
PhD or EngD
Lung Cancer kills over 30,000 people each year in the UK, accounting for 5.6% of all UK deaths. This
is greater than deaths from the next three most common malignancies combined (breast, colorectal
and prostate cancers). Survival rates for lung cancer in the UK are very poor and have not improved
in the last thirty years. For patients diagnosed between 1993 and 1995 and followed up to 2000,
only 5.5% are alive after 5 years. Surgery remains the only cure and surgical resection rates, a
marker of outcome are lower in the UK (11%) compared with the rest of Europe (17%) and North
America (21%) and vary by three-fold between health authorities in England.
Patients with lung cancer in the UK present at a later stage and have a higher co-morbidity than
patients in comparable European cities. One approach to dealing with the poor surgical rate and
overall survival is to adopt minimally invasive surgery in higher risk patients whose morbidity and
mortality with open surgery may have been prohibitive. This is even more important now because
the draft BTS guidelines on selection of patients with lung cancer surgery has lowered the threshold
for surgery such that less fit patients will now be offered surgery
Video assisted thoracic surgery (VATS) or minimally invasive surgery is associated with post
operative reduction in pain, loss of lung function and Immune activation. The length of hospital stay
is also reduced after specific procedures. Though VATS has become standard practice for specific
procedures such as in the treatment pneumothorax, it has been slow to be adopted in the curative
treatment of lung cancer. Fears that oncological clearance may be hampered resulting in a lower
long term survival and higher recurrence rates following VATS have been refuted. Indeed metaanalysis suggests that long term survival may be better after lung cancer resection via VATS.
Only 2.5 % of all major lung resections are performed via VATS but in individual centres in the hands
of experts this approaches 80%. One of the major barriers to the use of VATS lung resection is the
inadequate training available to minimize the effects of the learning curve. Though industry
sponsored animal training facilities in Europe are available, access is limited as is the excellent
mentorship of experienced surgeons.
Current models of VATS simulation rely on physical reality ‘Box trainers’ which are inadequate at
providing realistic scenarios. Hence there is a need to build more realistic simulators for training of
future thoracic surgeons.
This project aims to develop a realistic VATS simulator for training of new thoracic surgeons and for
experienced surgeon to practice prior to a real surgery.