Utilizing a 3D Printed Laparoscopic Nissen Fundoplication Model to Shorten a Resident's Learning Curve
August 15th, 2025
This study describes how 3D printed models effectively accelerate the rate at which advanced laparoscopic surgery skills used in Nissen Fundoplication are mastered by surgical residents during residency training, thereby enhancing future preparedness.
Our research evaluates whether a realistic 3D printing model can help surgical residents master complex laparoscopic surgical skills faster and more safely before they enter the operating theater. Residents often lack confidence in advanced procedures after standard training. We address the gap between basic simulation and the complexities of real operating room performance and suturing.
Our protocol uses a low-cost, reusable, and anatomically accurate model. It allows for risk-free practice of critical surgical steps, which isn't always feasible with other methods. Our finding provides a validated training pathway that shorten the learning curve.
This can directly lead to improve surgical proficiency, reduce complications, and ultimately better patient outcome. After performing 3D computed tomography, convert the DICOM profiles into STL format. Import the STL files into Magics 24 software by selecting File and then Import.
Run automatic fixing through the menu bar. Select Fix and choose Auto-Fix. Afterward, select menu bar, orientation, and create support to add support structures.
Next, to export the repaired and supported model, select the menu bar, File, Export, and STL. Using an LCD 3D printer, open the Chitubox software and click on Slice Settings under the Resin tab. Set the layer thickness to 0.1 millimeters.
Adjust the number of bottom layers to eight. Set the bottom layer lift speed to 90 millimeters per minute, and the lift speed to 80 millimeters per minute. Now, clean the printed mold thoroughly in an ultrasonic cleaner using ethanol solvent at a frequency of 40 kilohertz for three to five minutes.
Complete the secondary curing of the mold in a UV chamber. After curing, apply a thin layer of petroleum jelly to the inner surfaces of the mold components to act as a release agent. Next, prepare two component zero degree silicone.
Place the mixture in an environment maintained at an ambient temperature of 22 to 25 degrees Celsius to prevent high temperatures from affecting the operational time. Place the silicone mixture into a vacuum chamber set to a vacuum level of minus 0.09 megapascal for a defoaming time of eight minutes. Pour the prepared silicone from the vacuum chamber into the organ mold and observe to ensure that the silicone fills the mold evenly and that no large air bubbles are visible on the surface.
Allow the silicone to fully cure in an airtight environment maintained at approximately 25 degrees Celsius for one hour. After curing, carefully remove the mold to obtain the final silicone organ model. Examine the surface of the silicone model to ensure completeness and clarity of anatomical structures.
Place the 3D printed organ models according to the corresponding anatomical layout. Lay out the esophagus attached to the stomach so that it enters the mediastinum through the opening between the crura and the gastric fundus. Now, place the omentum, liver, and bile duct adjacent to the stomach, securing them in position with pins.
Then place the skin onto the plastic platform and secure it. Connect the internal platform light to a power source to enhance visibility. Next, make three incisions on the skin for ergonomic trocar positioning.
Insert a 12 millimeter trocar for the 30 degree laparoscope at the center to establish the triangle of vision. Position two 12-millimeter trocars on either side for laparoscopic needle drivers, atraumatic graspers, and laparoscopic scissors. Then secure the laparoscope using a clamp and connect it to the USB port of a high-definition display screen on either a television or laptop.
Place a 2-0 silk suture with a CT-1 needle inside the model. Gently pass a Penrose Drain behind the already mobilized posterior esophagus to serve as a retractor. Apply gentle traction to the drain to retract the esophagus, ensuring clear visualization of the right and left crura of the diaphragm.
Then identify the bilateral diaphragmatic crura and place five interrupted sutures to approximate them securely without tension. Verify that the crura are firmly closed and adequately aligned to ensure proper approximation of the diaphragmatic pillars. Next, place the mesh symmetrically on the diaphragm.
Suture the sides of the mesh evenly to the diaphragm to ensure it lies flat without wrinkling, while maintaining a clear margin between the mesh and the esophageal wall. After passing the bougie through the esophagus into the stomach, perform the shoe shine maneuver to mobilize and align the gastric fundus. Wrap the fundus over two to three centimeters of the esophagus, ensuring a floppy, tension-free, 360 degree fundoplication wrap no longer than two centimeters.
Then close the wrap with three interrupted sutures over a 1.5 centimeter length and inspect thoroughly to ensure that the wrap is firmly secured. Conduct a final assessment of live operating room performance under expert surgeon supervision, ensuring all steps meet procedural standards. The experimental group achieved significantly higher OSAT scores compared to the control group, while also completing the procedure in a notably shorter duration.
Training session performances showed a consistent increase in total scores from session one to session six, reaching values close to the expert benchmark. Median performance scores improved steadily across training sessions. Session starting from 4.5 in session one and reaching 9.0 in session six.
A strong inverse relationship was observed between procedure completion time and total score, with completion time decreasing as scores increased. Expert evaluations confirmed the model was easy to use, highly suitable for surgical training, and effective in improving surgical skills.
Overview
This study evaluates the effectiveness of a 3D printed model in accelerating the mastery of advanced laparoscopic surgical skills among surgical residents. The model addresses the gap between basic simulation and real operating room complexities, enhancing surgical preparedness.
Key Study Components
Area of Science
- Surgical Training
- 3D Printing Technology
- Laparoscopic Surgery
Background
- Residents often lack confidence in advanced surgical procedures after standard training.
- There is a need for effective training methods that bridge the gap between simulation and real-life performance.
- 3D printed models can provide anatomically accurate and reusable training tools.
- Improving surgical skills can lead to better patient outcomes and reduced complications.
Purpose of Study
- To determine if a realistic 3D printing model can enhance the learning curve for surgical residents.
- To validate a training pathway that allows for risk-free practice of critical surgical steps.
- To assess the impact of the model on surgical proficiency and confidence.
Methods Used
- Creation of a low-cost, anatomically accurate 3D printed model.
- Training sessions using the model to practice laparoscopic techniques.
- Evaluation of performance through OSAT scores and procedure completion times.
- Expert assessments of the model's usability and effectiveness in training.
Main Results
- The experimental group achieved significantly higher OSAT scores compared to the control group.
- Training session performances showed consistent improvement, nearing expert benchmarks.
- A strong inverse relationship was observed between completion time and total score.
- Expert evaluations confirmed the model's suitability for surgical training.
Conclusions
- The 3D printed model effectively enhances the training of surgical residents.
- It provides a validated pathway for mastering complex laparoscopic skills.
- Utilizing such models can lead to improved surgical outcomes and resident confidence.
Frequently Asked Questions
Executive Industry Relevance
Accelerating the acquisition of advanced laparoscopic skills is critical for reducing procedural risk and improving surgical proficiency in translational research and device validation. The use of anatomically accurate, reusable 3D-printed models enables quantifiable skill development, supporting predictive confidence in technical training outcomes. This approach addresses a key inflection point in surgical device and procedural pipeline readiness, facilitating reproducible and scalable training paradigms for enterprise R&D.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables rigorous hypothesis testing of procedural proficiency using quantifiable performance metrics.
- Supports functional validation of surgical techniques in anatomically relevant systems.
- Facilitates mechanistic de-risking by isolating critical procedural steps for targeted skill assessment.
Screening & Assay Development
- Provides standardized, reproducible models for evaluating technical competency across trainees.
- Generates quantitative outputs such as OSATS scores and procedure times for benchmarking.
- Enables scalable, risk-free screening of advanced surgical skills prior to clinical translation.
Translational & Preclinical Research
- Aligns training outputs with clinically relevant endpoints, supporting translational continuity.
- Reduces variability in preclinical procedural performance, enhancing predictive value for device and technique validation.
- Supports risk-adjusted advancement of surgical innovations through validated skill acquisition pathways.
Pipeline & Workflow Integration
This validated training protocol integrates into the continuum from early technical skill discovery to preclinical procedural validation, supporting both device and technique development pipelines.
- Discovery Biology: Quantitative assessment of procedural steps enables robust hypothesis testing and pathway clarification in surgical skill acquisition.
- Screening: Standardized models and scoring systems ensure reproducibility and readiness for downstream clinical evaluation.
- Analytics: Objective metrics such as OSATS scores and completion times facilitate cross-condition comparisons and performance tracking.
- Translational Research: Training outputs are directly aligned with clinical performance benchmarks, supporting seamless transition to in vivo validation.
- Enterprise Reuse: The reusable model and protocol provide a scalable platform for ongoing technical training and device assessment.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in technical skill acquisition and reduces mechanistic ambiguity in procedural training.
- Operational Value: Delivers standardized, reproducible, and scalable training infrastructure for surgical skill development.
- Strategic Value: Enables data-driven go/no-go decisions for advancing surgical techniques and devices, improving capital efficiency.
- Portfolio Impact: Supports risk-adjusted prioritization and advancement of surgical innovations within enterprise R&D pipelines.
Implementation Considerations
- Requires expertise in 3D modeling, printing, and surgical technique assessment.
- Needs access to 3D printing infrastructure and quantitative performance analytics.
- Demands cross-team standardization of scoring and procedural benchmarks.
- Adaptation may be needed for different anatomical or procedural models.
- Limitations include the need for expert validation and alignment with clinical endpoints.
