Page 364 - IJB-9-5

International Journal of Bioprinting Multifunctional hydrogel surgical training model

1. Introduction possible to provide an environment similar to physiological
characteristics and suitable for surgical operations, which
In clinical surgery, laparoscopic and robotic surgeries are is important for conducting medical skills training and
developing rapidly. Still, due to the high complexity of robotic surgery simulation training for doctors and nurses.
the procedures, training surgeons in surgical operations
is essential to ensure safe and effective completion of In recent years, simulated physical organ models have
these surgical treatment procedures. Training can help been gradually introduced into surgical training [10,11] . In the
surgeons safely and efficiently navigate the learning curve era of robotic surgery, it is impractical to purchase the da
of many surgical procedures that are operationally difficult Vinci surgical robot, which is worth of multimillion dollar,
and costly in terms of trial and error, further enhancing specifically for training in wet models (animal or fresh
surgeon confidence, improving medical level, and reducing human cadavers or animal organs), and it is less feasible to
surgical risk [1,2] . With advances in surgical care systems, apply surgical robots in hospital operating rooms for the
the establishment of quality assurance goals, expensive aforementioned wet model training. The risk of losing the
operating room time and increased surgical complexity, sense of touch with a completely new operating platform
and a greater emphasis on patient safety, the traditional owing to insufficient specialized training has become an
single model of relying on surgical skills acquired from the international concern. The use of simulated physical organ
operating room experience has led to a significant decrease models instead of living organisms for surgical training
in surgical training for young surgeons. Particularly in has become a frontier hot research direction in the field of
special times like the novel coronavirus epidemic, many medical simulation research, with significant application
hospitals have significantly reduced emergency and elective advantages and prospects. However, most of the previous
surgical volumes, and new challenges have been posed for studies have used silicone materials and single-function
[3]
training time and caseload training standards . Indeed, it hydrogel material models [12-15] , which cannot provide a
is unethical and unacceptable for students at any level of good realistic sensation of suture and surgical electric
[4]
training to perform new techniques directly on patients . instrument cutting as well as wet and soft biological tissues
Regulatory authorities such as the American Council for due to the variability of their physicochemical structural
Accreditation of Medical Education (ACGME) require that properties. In addition, the surgical responses generated
surgeons be provided with surgical simulation programs by electrosurgical instruments such as ultrasonic scalpel
to complete surgical training in the laboratory to meet and ligasure and even electrocoagulation effect, which
the requirements. However, the current status of surgical are routinely used in the current surgical simulation
operative training for surgeons in China could be better. process, cannot be simulated, such as electrocoagulation
Due to differences in medical conditions, young surgeons operation to make the material to be realistically coked
have few opportunities to perform hands-on surgery. Jiang and thus coagulated to stop bleeding, ultrasonic scalpel
et al. concluded that the most significant challenge facing to cut substantial organ realism, and coagulation to close
young Chinese surgeons and surgical trainees is the need blood vessels. Usually, surgical procedures are dissected
[5]
for more opportunities for hands-on learning . along layers of tissue, which requires materials that need to
With the increasing demand for surgical training, digital reflect the nuances between layers in the simulation model,
[16]
simulators such as virtual reality (VR) have been gradually which is difficult to achieve with current models . These
applied in some large medical centers [6,7] . However, digital are precisely the difficulties faced by the current bionic
surgical simulation training is not only expensive, but gradient structured soft models for surgical training and
surgical training with these models is only at the primary are the key to the design of surgical training models.
level. Advanced surgical simulation training consists of two As a wet and slippery soft material, hydrogel is a class of
types: biological models (in vivo and in vitro) and simulated hydrophilic polymeric materials with a three-dimensional
physical organ models. The disadvantages of biological (3D) network structure, whose 3D polymer network is
models are the individual differences, high cost and ethical filled with a large amount of bound water, interfacial water,
implications, the risk of infection and contamination, and free water media . Hydrogels have physiological
[17]
and the inability to simulate specific scenarios in some characteristics similar to biological tissues and organs,
surgeries, which are the key to surgical risks that can arise which are also widely used in biomedical research .
[18]
due to unfamiliarity . Compared with the direct use of In addition, the processing and preparation techniques
[8]
live organs or animal experiments, or even human clinical and design solutions of hydrogels have been gradually
experiments, simulated physical organ models have the improved due to the rapid development of 3D printing
advantages of being low cost, ethical, and easy to operate technology, a fast-prototyping method that generates
and execute . Through reasonable structural design and 3D objects directly from computer-aided design (CAD)
[9]
material selection of physical organ models, it is also

Volume 9 Issue 5 (2023) 356 https://doi.org/10.18063/ijb.766