Validity of a Soft and Flexible 3D-Printed Nissen Fundoplication Model in Surgical Training

Yangyi Zhang, Jianfu Xia, Jiye Zhang, Jinlei Mao, Hao Chen, Hui Lin, Pan Jiang, Xinzhong He, Xiaodong Xu, Mingzhu Yin, Zhifei Wang

Article ID: 546
Vol 8, Issue 2, 2022, Article identifier:

VIEWS - 256 (Abstract) 76 (PDF)



Rapid development of three-dimensional (3D) printing technique has enabled the production of many new materials for medical applications but the dry laboratory surgical training model made of soft and flexible materials is still insufficient. We established a new 3D-printed Nissen fundoplication training model of which materials simulate the real mechanical properties. In this study, 16 participants were divided into two groups: Experimental group and control group. The validity of model was tested using Likert scale by the experts and the experimental group. To evaluate the efficacy, performances of the experimental group were scored at the first, fourth, and eighth training by OSATS system and the duration of procedure was compared through the use of recorded video. Meanwhile, an ex vivo model was used to compare the performance of the experiment group and control group after the training in the same way. Our results showed that the 3D-printed model can support the future surgical applications, help improve surgical skills, and shorten procedure time after training.


3D-printed model, Nissen fundoplication, Surgical training, Soft materials

Full Text:



Liaw CY, Guvendiren M, 2017, Current and Emerging Applications of 3D Printing in Medicine. Biofabrication, 9:024102.

Pugliese L, Marconi S, Negrello E, et al., 2018, The Clinical Use of 3D Printing in Surgery. Updates Surg, 70:381–88.

Ganguli A, Pagan-Diaz G J, Grant L, et al., 2018, 3D Printing for Preoperative Planning and Surgical Training: A Review. Biomed Microdevices, 20:65.

Yap YL, Sing SL, Yeong WY, 2020, A Review of 3D Printing Processes and Materials for Soft Robotics. Rapid Prototyp J, 26:1345–61.

Wallin TJ, Pikul J, Shepherd RF, 2018, 3D Printing of Soft Robotic Systems. Nat Rev Mater, 3:84–100.

Stratton S, Manoukian OS, Patel R, et al., 2018, Polymeric 3D Printed Structures for Soft-Tissue Engineering. J Appl Polym Sci, 135:45569.

Jin Z, Li Y, Yu K, et al., 2021, 3D Printing of Physical Organ Models: Recent Developments and Challenges. Adv Sci (Weinh), 8:e2101394.

Li X, Liu B, Pei B, et al., 2020, Inkjet Bioprinting of Biomaterials. Chem Rev, 120:10793–833.

Jiang T, Munguia-Lopez JG, Flores-Torres S, et al., 2019, Extrusion Bioprinting of Soft Materials: An Emerging Technique for Biological Model Fabrication. Appl Phys Rev, 6:011310.

Ng WL, Lee JM, Zhou MM, et al., 2020, Vat Polymerization based Bioprinting-Process, Materials, Applications and Regulatory Challenges. Biofabrication, 12(2):022001.

Li WL, Mille LS, Robledo JA, et al., 2020, Recent Advances in Formulating and Processing Biomaterial Inks for Vat Polymerization-Based 3D Printing. Adv Healthc Mater, 9(15):2000156.

Pietrabissa A, Marconi S, Negrello E, et al., 2020, An Overview on 3D Printing for Abdominal Surgery. Surg Endosc Other Intervent Tech, 34(1): 1-13.

Kwon J, Choi J, Lee S, et al., 2020, Modelling and Manufacturing of 3D-printed, Patient-specific, and anthropomorphic gastric phantoms: A pilot study. Sci Rep, 10:18976.

Ratinam R, Quayle M, Crock J, et al., 2019, Challenges in Creating Dissectible Anatomical 3D Prints for Surgical Teaching. J Anat, 234:419–37.

Yadlapati R, Hungness ES, Pandolfino JE, 2018, Complications of Antireflux Surgery. Am J Gastroenterol, 113:1137–47.

Wu JM, Chen D, 2020, The Evolution and Expectation of Surgical Options for Gastroesophageal Reflux Disease. Zhonghua Wai Ke Za Zhi, 58:677–82.

Xiao YL, Zhou LY, Hou XH, et al., 2021, Chinese Expert Consensus on Gastroesophageal Reflux Disease in 2020. J Dig Dis, 22:376–89.

La Torre M, Caruso C, 2013, The Animal Model in Advanced Laparoscopy Resident Training. Surg Laparosc Endosc Percutan Tech, 23:271–5.

Daly SC, Wilson NA, Rinewalt DE, et al., 2014, A Subjective Assessment of Medical Student Perceptions on Animal Models in Medical Education. J Surg Educ, 71:61–4.

Tanaka H, Yoshino H, Kobayashi E, et al., 2004, Molecular Investigation of Hepatitis E Virus Infection in Domestic and Miniature Pigs Used for Medical Experiments. Xenotransplantation, 11:503–10.

Copaescu C, Dragomirescu C, 2009, The Pig Model for the Laparoscopic Antireflux Surgery Training. Chirurgia (Bucur), 104:309–15.

He J, Fang Y, Chen X, 2015, Surgical Models of Gastroesophageal Reflux with Mice. J Vis Exp, 102:e53012.

Filho EV, Goldenberg A, Costa HO, 2005, Experimental Model of Gastroesophageal Reflux in Rats. Acta Cir Bras, 20:437–44.

Wei F, Xu M, Lai X, et al., 2019, Three-dimensional Printed dry Lab Training Models to Simulate Robotic-assisted Pancreaticojejunostomy. ANZ J Surg, 89:1631–5.

Horgan S, Pohl D, Bogetti D, et al., 1999, Failed Antireflux Surgery what have we Learned from Reoperations? Arch Surg, 134:809–15.

Lundell L, 2004, Complications after Anti-reflux Surgery. Best Pract Res Clin Gastroenterol, 18:935–45.

Maret-Ouda J, Wahlin K, El-Serag HB, et al., 2017, Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux. JAMA, 318:939–46.

Lin HH, Lonic D, Lo LJ, 2018, 3D Printing in Orthognathic Surgery a literature review. J Formos Med Assoc, 117:547–58.

Weidert S, Andress S, Suero E, et al., 2019, 3D Printing in Orthopedic and Trauma Surgery Education and Training: Possibilities and Fields of Application. Unfallchirurg, 122:444–51.

Hatala R, Cook DA, Brydges R, et al., 2015, Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence. Adv Health Sci Educ Theory Pract, 20:1149–75.



  • There are currently no refbacks.

Copyright (c) 2022 Author(s).

License URL: