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A New 3D-Printed LNF Training Model
A B C

D E F

G H I

Figure 3. Ex vivo Nissen fundoplication procedure. (A) Participants were practicing on laparoscopic surgery platform. (B) Ex vivo swine
organ. (C) Dissociation of lesser omental sac. (D) Establishment posterior esophagus channel. (E) Hiatal hernia closure. (F) Fixation mesh
on diaphragm. (G) Fundoplication through esophagus. (H) Shoeshine maneuver. (I) Making a wrap using interrupted suture.

Table 2. Likert scale results of experts and experimental group due to dynamical mechanical stress, and difficulty in
Parameters Experts Experimental reestablishment of anti-reflux barrier which prevents the
[15]
group wrap from being too tight or too loose . Being unfamiliar
The model is similar with 4.36±0.50 - with the key procedure during surgery can cause severe
[26]
real tissue or organ. iatrogenic complications . According to a study involving
The model is easy to use. 4.52±0.50 4.24±0.12 2655 patients, 4.1% of patients developed complications
Using model in surgical 4.80±0.45 - within 30 days, including infection (1.1%), bleeding
training is reasonable. (0.9%), and iatrogenic esophageal perforation (0.9%). The
[27]
The model can help improve 4.28±0.08 4.76±0.16 recurrence rate of GERD was 17.7% . Cadaver model or
surgical skills. animal models are still the most commonly used training
Training using the model can 4.36±0.23 4.66±0.11 models for this procedure in China; however, these models
help reduce surgical risk to are expensive and may raise ethical concerns, and thus,
patient. an alternative model for Nissen fundoplication training is
The model can help 4.32±0.46 4.29±0.18 now in a great demand in China [14,18] .
participants concentrate in 3D printing is an appropriate alternative technique for
learning. fabricating models to be used in surgical training. 3D-printed
The model can help boost 4.24±0.19 4.73±0.15 products can be developed rapidly and become commonly
confidence in future surgery. used as biomaterials and applied in the fields of medicine
The model can enhance 4.28±0.19 4.63±0.17 and surgery [1,28] . Different types of surgical simulation
tactile feedback. models offer an economic-friendly way to multiple medical
[3]
The model is recommended 4.80±0.45 - approaches . However, despite significant progress, the
for use in the training of mechanical simulation of soft tissue is not optimized yet,
anti-reflux surgery. which greatly hampers its application in surgical training
Data are expressed as mean±standard variation. (for example, the mostly common techniques applied in
surgery, such as suturing and dissecting). In our study, we
anatomical complexities of esophagogastric junction, attempted to generate a soft and flexible surgical training
possibilities of disruption, herniation or slippage of wrap model for Nissen fundoplication procedure which considers
66 International Journal of Bioprinting (2022)–Volume 8, Issue 2