**7. Future direction and research**

Modern technological advancements have permitted the development of surgical simulators that mimic complex operations specific to the anatomical demands of individual patients. By allowing surgeons to rehearse the precise case they

*Perspective Chapter: Simulation in Complex Laparoscopic Digestive Surgery DOI: http://dx.doi.org/10.5772/intechopen.108224*

#### **Figure 4.** *VR application for the preoperative demonstration of 3D liver models [62].*

will be conducting on models that accurately mimic their patients, these patientspecific surgical simulators reach the maximum level of realism. Furthermore, telesurgery is developing into a genuine tool for skilled surgeons to mentor novice surgeons in complex surgical procedures thanks to augmented reality and wireless technology [60].

Three-dimensional printing technology is also evolving with new applications in surgery being developed. For instance, in liver surgery, anatomy data can be extracted from the CT or MRI scans of a patient with a liver tumor and converted into a digital 3D model which can be 3D printed. The final model can show the surgeon the relationship between the tumor and surrounding structures aiding with surgical planning [61]. Future techniques of printing into deformable biosynthetic materials may facilitate its use in high-fidelity simulators.

Patient-specific simulators have also been developed. A virtual 3D model can be created using a patient's CT data. This allows the surgeon to practice laparoscopic operations in a virtual environment with realistic representations of the patient's anatomy before performing them on the real patient (**Figure 4**) [62]. The simulator's overall accuracy is high, allowing the tumor, arteries, and veins to be visualized. The time it takes to develop these simulations is short, with the hepatectomy and pancreatectomy simulators needing approximately 2.5 hours [63]. As a result, these technologies may have a role in preoperative planning and preparation for complex procedures. However, because patient-specific VR simulators are a novel technology, further research is needed to validate them.

With all models of simulation, an appropriate educational program or curriculum needs to complement its utility. Therefore, research into the applicability of models to facilitate acquiring or mastering procedural skills needs to involve an entire educational program and not just simply time spent on a simulation model. Furthermore, future evidence should focus on measuring and obtaining clinical outcomes associated with high-quality patient care to ultimately demonstrate simulations' effectiveness.
