The Training of Resident Surgeons in Single-Port Thoracoscopic Surgery Wound Position Selection

The Role of a Metaverse Surgical Simulation System in Guiding Incision Site Selection for Uniportal Video-Assisted Thoracoscopic Surgery

the metaverse system applied to the training of wound location selection for singleport thoracoscopic surgery. The experimental design is two groups of 40 computer tomography located superficially less than 2 cm lung nodule patients, one group uses the metaverse system to let resident physicians simulate the wound position on the digital twin organs of each patient, and the other group does not use it. The investigators will evaluate the surgeon's satisfaction with the surgical wound position and urgicalrelated results (such as surgery time, blood loss, etc.). The investigators expect that the system will help improve the appropriateness of resident physicians' choice of wound location for high-difficulty single-port thoracoscopic surgery, help them cross the first threshold necessary to familiarize themselves with the surgery faster, and accelerate learning.

The evolution of single-port thoracoscopic surgery, due to advancements in instrumentation and video technology, has seen a leap in progress since the 2010s.

Today, single-port thoracoscopic surgery has become the mainstream at NTU Thoracic Surgery, capable of performing simple wedge resections or complex pneumonectomies. Single-port thoracoscopic surgery, using only a single wound, aids patients in quickly regaining their preoperative normal life functions, with further reductions in pain. However, its learning curve is steep, with the appropriate choice of wound location being one of the most important thresholds for resident physicians to master this technique. Currently, NTU Surgery and the Media Lab have jointly developed a metaverse surgical simulation platform (OpVerse), creating digital twin organ models through 3D reconstruction software and modeling engines. In mixed reality, including lesion location and anatomical variations, are no different from specific real patients. Users can view and operate CT images and 3D models arbitrarily, mark important structural positions and directions, and measure distances with an XR helmet. The model can also be cross-referenced with CT through cross-sectional positioning. The investigators set up a thoracoscopic simulation lens in the system, superimposing the digital twin model on the patient on the operating table, and using the CT cross-section comparison function in the metaverse system to find the lesion location, resident physicians can repeatedly simulate the wound position through the system, and mark the expected entry wound position on the patient through virtual reality overlay. This project plans to conduct a randomized trial to explore the effectiveness of the metaverse system applied to the training of wound location selection for singleport thoracoscopic surgery. The experimental design is two groups of 40 computer tomography located superficially less than 2 cm lung nodule patients, one group uses the metaverse system to let resident physicians simulate the wound position on the digital twin organs of each patient, and the other group does not use it. The investigators will evaluate the surgeon's satisfaction with the surgical wound position and surgical related results (such as surgery time, blood loss, etc.).

The investigators expect that the system will help improve the appropriateness of resident physicians' choice of wound location for high-difficulty single-port thoracoscopic surgery, help them cross the first threshold necessary to familiarize themselves with the surgery faster, and accelerate learning.

Inclusion Criteria:

• Aged 18 years or older.
• Diagnosed with a lung nodule no larger than 2cm in diameter. The lesion depth must be located within the outer third of the lung.
• Scheduled to undergo computer tomography-guided single-port thoracoscopic wedge resection at National Taiwan University Hospital (NTUH) or National Taiwan Cancer Center (NTUCC).
• Participants who have provided written informed consent for their imaging data to be used by the team to create digital twin models.

Exclusion Criteria:

• Patients with lesions larger than 2 cm.
• Patients not planned for single-port thoracoscopic wedge resection with computed tomography localization.
• Patients who have not provided written consent.
• Members of vulnerable populations.

Inclusion Criteria (Resident Physician):

• Third-year to fifth-year residents in the Department of Thoracic Surgery at National Taiwan University Hospital.

Exclusion Criteria (Resident Physician):

• Residents who are unwilling to participate in the study and decline to sign the consent form.
• Residents with a history of cybersickness.