SMART VATS: simulation model of an affordable and realistic trainer for video-assisted thoracic surgery (a prospective simulation cohort)

Background: Video-assisted thoracic surgery (VATS) is associated with reduced morbidity and mortality compared to open thoracotomy. However, access to structured VATS training remains limited, particularly in low-resource countries. We developed SMART-VATS (Simulation Model of an Affordable and Realistic Trainer for Video-Assisted Thoracic Surgery), a low-cost hybrid simulation model to facilitate the early acquisition of fundamental lung resection VATS skills. Materials and methods: This prospective analytical feasibility simulation study evaluates the SMART-VATS model using ovine heart–lung blocks. Participants performed simulated uniportal or multiportal lobectomies in a hemi-thorax-shaped box-trainer. Primary outcomes focused on anatomical realism and feasibility via a 5-point Likert scale. Secondary metrics included expert-led performance assessments. Statistical analysis compared junior and senior cohorts to validate the model’s educational utility and haptic fidelity. Results: Seventy-four participants (51 residents and 23 seniors) completed 7 simulation sessions. The overall success rate was 77%, with no significant statistical disparity between seniority levels ( P = 0.558). Vascular injuries occurred in 16.2% of cases, primarily among juniors ( P = 0.32). Participants highly rated the model’s haptic feedback (94%), color-coded vascular identification (92%), and realism (90.3%), noting its close resemblance to actual surgical conditions. Although the absence of lymph nodes was noted, the SMART-VATS model was validated as an affordable (100%), reproducible (96%), and easy-to-prepare training tool (82%). Conclusions: Our study suggests that SMART-VATS is a feasible, affordable, and reproducible early-phase VATS training model. It provides a valuable foundational platform for lung-resection-skill acquisition, particularly in resource-limited environments. Further studies are required to validate objective skill transfer to clinical performance.