[Training in Robot-assisted Thoracic Surgery: Opportunities, Limitations, and the Need for Structured Curricula]

Robot-assisted thoracic surgery (RATS) has emerged as an important extension of the minimally invasive thoracic surgical armamentarium. Currently, access to robotic platforms remains limited and unevenly distributed, resulting in considerable variability in training opportunities. This review aims to evaluate the current role of RATS in thoracic surgical education and to identify existing challenges and future perspectives.

A narrative review was conducted based on a contemporary literature search. Relevant international publications addressing the adoption of RATS, training concepts, learning curves, educational strategies, and the development of national and international curricula were reviewed and analysed.

The available literature indicates that RATS provides several educational advantages, including highly standardised surgical workflows, superior visualisation, and direct teaching opportunities through dual-console systems. These features facilitate stepwise skills acquisition and have been associated with shorter learning curves compared with conventional approaches. Nevertheless, access to robotic systems in Germany remains restricted to a limited number of centres, resulting in substantial disparities in training exposure. Existing industry-supported training programs primarily target experienced surgeons, whereas structured, technology-independent curricula for residents and early-career surgeons are still limited. Supplementary educational formats such as simulation-based training, boot camps, wet labs, and cadaver laboratories may help bridge this gap and standardise competency acquisition. At the same time, increasing reliance on robotic techniques may contribute to a decline in proficiency in video-assisted thoracic surgery (VATS) and open procedures, which remain essential for managing complex cases and conversions.

RATS has considerable potential to enhance thoracic surgical training, effectively enhances thoracic surgical training and provides an effective environment to competency-based education. However, its successful integration into residency and fellowship programs requires widespread implementation of standardised curricula that combine robotic training with the preservation of conventional surgical skills. The introduction of the first German Society for Thoracic Surgery (DGT)-certified multi-level RATS curriculum in 2025 is an important milestone toward achieving this goal.