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Page 10 of 14 Farinha et al. Mini-invasive Surg 2023;7:38 https://dx.doi.org/10.20517/2574-1225.2023.50

Glybochko Evaluate effectiveness of personalized 3D Used time-based metrics and blood loss None identified Elasticity and density similar to real kidney Can contribute to improvement of surgical
[28]
et al. printed models for pre-surgical planning skills and facilitate selection of optimal
surgical tactics
Ohtake Examine effectiveness of the model as a Used Lickert-scale questionnaires to evaluate None identified Significant differences between novice and Can be used daily as a training tool for LPN
[33]
et al. tool for practicing LPN realism and utility as training tools expert performance
Used GOALS to score performance Improvement in the learning curve
Used procedure-specific metrics

Makiyama Describe and validate a patient-specific Visual analog scales to assess anatomical None identified Reproduced patient anatomy Useful as a preoperative training tool
[30]
et al. simulator for laparoscopic surgery integrity and utility and intraoperative High scores in the utility of simulations and Improvements still needed
confidence during subsequent surgical surgeons’ intraoperative confidence
procedures
Hung Evaluate face, content, construct, and Questionnaires to evaluate realism and None identified Differentiated performance of experts from Although validated, several areas need
[29]
et al. concurrent validity usefulness for training non-experts improvement, particularly with the teaching
Used GEARS and computer-based Highly useful in training residents and fellows of advanced technical skills
performance metrics but less so for experienced surgeons
Inferior utility in training compared with
porcine
Scored high to teach surgical anatomy and
procedure steps

CROMS: Clinically relevant outcome measures; GEARS: global evaluative assessment of robotic skills; GOALS: global operative assessment of operative skills; LPN: laparoscopic partial nephrectomy; NASA-TLX:
NASA-task load index; PN: partial nephrectomy; RALPN: robot assisted partial nephrectomy; RAPN: robot-assisted partial nephrectomy; TM: training model.

Although the preparation and use of 3D printed models were labor intensive, and monofilament sutures were recommended (e.g., braided sutures easily torn
this material) [18,19] , they involved fewer logistic concerns than the use of animal models [18,19] . They are simple, easy to set up, and likely have a practically
indefinite shelf life. The price was reported in some studies, purporting its economic value, but the cost of the 3D printer was not considered [17,19,23,26] .

The feasibility of incorporation into a training course was the focus when selecting clinically relevant steps to emulate. Therefore, most of the 3D printed
models focused on simulating tumor resection and renorrhaphy. Some models include other anatomical structures, potentially increasing their realism and

educational value [19,26,29] .

The exponential increase in computing power over the last decade makes VR/AR TMs very promising. By including different teaching tasks, patient-specific

TMs allow preoperative rehearsal. However, signal processing delays induce a lack of realistic tissue responsiveness during the dissection of tissue planes, tissue
excision, suturing, knot tying, and bleeding, which significantly compromises the capacity of VR simulation to accurately emulate the PN procedure and thus
their value as a training tool [27,28] .