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Surgical training simulation modalities in minimally invasive surgery: How to achieve evidence-based curricula by translational research - 08/03/25

Doi : 10.1016/j.amjsurg.2025.116197 
Philipp Seeger a, Nikolaos Kaldis b, Felix Nickel a, Thilo Hackert a, Panagis M. Lykoudis b, c, 1, , Anastasios D. Giannou a, d, 1,
a Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 
b 3rd Department of Surgery, Attiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece 
c Division of Surgery and Interventional Science, University College London (UCL), London, UK 
d Section of Molecular Immunology und Gastroenterology, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 

Corresponding author. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of GeneralVisceral and Thoracic SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany⁎⁎Corresponding author. 3rd Department of Surgery, Attiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece.3rd Department of SurgeryAttiko University HospitalNational and Kapodistrian University of AthensAthensGreece

Abstract

Background

Surgery has evolved from a hands-on discipline where skills were acquired via the “learning by doing” principle to a surgical science with attention to patient safety, health care effectiveness and evidence-based research. A variety of simulation modalities have been developed to meet the need for effective resident training. So far, research regarding surgical training for minimally invasive surgery has been extensive but also heterogenous in grade of evidence.

Methods

A literature search was conducted to summarize current knowledge about simulation training and to guide research towards evidence-based curricula with translational effects. This was conducted using a variety of terms in PubMed for English articles up to October 2024. Results are presented in a structured narrative review.

Results

For virtual reality simulators, there is sound evidence for effective training outcomes. The required instruments for the development of minimally invasive surgery curricula combining different simulation modalities to create a clinical benefit are known and published.

Conclusion

Surgeons are the main creators for minimally invasive surgery training curricula and often follow a hands-on oriented approach that leaves out equally important aspects of assessment, evaluation, and feedback. Further high-quality research that includes available evidence in this field promises to improve patient safety in surgical disciplines.

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Graphical abstract




Image 1

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Highlights

Surgical training in the OR lacks structure, patient safety, and cost-efficiency; validated assessments are vital.
Simulated setups (dry/wet labs, VR) enhance skills; box trainers and VR offer feedback, flexibility, and cost benefits.
Curriculums must define strategies, assess needs, and adapt based on patient outcomes and training results.
Skill transfer to better patient outcomes remains a knowledge gap requiring further research.

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© 2025  The Authors. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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