Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.

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Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE • To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System. PATIENTS AND METHODS • Participants attending the 2010 International Robotic Urology Symposium were invited to experience RoSS. Afterwards, participants completed a survey regarding the appropriateness of the simulator as a teaching tool. RESULTS • Forty‐two subjects including surgeons experienced with robotics (n= 31) and novices (n= 11) participated in this study. • Eighty per cent of the entire cohort had an average of 4 years of experience with robot‐assisted surgery. • Eleven (26%) novices lacked independent robot‐assisted experience. The expert group comprised 17 (41%) surgeons averaging 881 (160–2200) robot‐assisted cases. Experts rated the ‘clutch control’ virtual simulation task as a good (71%) or excellent (29%) teaching tool. • Seventy‐eight per cent rated the ‘ball place’ task as good or excellent but 22% rated it as poor. • Twenty‐seven per cent rated the ‘needle removal’ task as an excellent teaching tool, 60% rated it good and 13% rated it poor. • Ninety‐one per cent rated the ‘fourth arm tissue removal’ task as good or excellent. • Ninety‐four per cent responded that RoSS would be useful for training purposes. • Eighty‐eight per cent felt that RoSS would be an appropriate training and testing format before operating room experience for residents. • Seventy‐nine per cent indicated that RoSS could be used for privileging or certifying in robotic surgery. CONCLUSION • Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity.

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ObjectiveTo validate robot‐assisted surgery skills acquisition using an augmented reality (AR)‐based module for urethrovesical anastomosis (UVA).MethodsParticipants at three institutions were randomised to a Hands‐on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank‐sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross‐over group).ResultsA total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention.ConclusionTraining in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.

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