Innovations and trends in hepatobiliary surgery education: Embracing technological advancements for enhanced surgical training

Abstract

The landscape of hepatobiliary surgical education has undergone a significant transformation with the integration of advanced technologies such as three-dimensional modeling, virtual reality, augmented reality, and artificial intelligence. This review synthesizes recent advancements in surgical education, examining the role of these technologies in improving anatomical understanding, surgical skill acquisition, and overall trainee engagement. Evidence from randomized controlled trials, systematic reviews, and cohort studies shows that immersive training tools, including virtual reality, augmented reality, and haptic feedback, outperform traditional apprenticeship methods in fostering cognitive and psychomotor skills. Artificial intelligence applications provide real-time feedback, further enhancing learning efficiency. However, these technologies should complement, rather than replace, traditional hands-on training. Some challenges remain to be addressed, such as high costs, infrastructure requirements, and limited long-term validation of these technologies. The review concludes that while these innovations offer promising educational benefits, further research is needed to standardize their application and evaluate their long-term impact on surgical outcomes.

Key Words: Immersive learning; Technology integration; Surgical training; Haptic feedback; Artificial intelligence; Augmented reality; Virtual reality; Three-dimensional modeling; Hepatobiliary surgery education

Core Tip: Technological innovations like three-dimensional modeling, virtual reality, augmented reality, and artificial intelligence are transforming hepatobiliary surgery education by enhancing anatomical understanding and skill development. While these tools offer substantial benefits, they should complement, not replace, traditional hands-on training. Real-world practice—such as tissue handling and patient interaction—is essential for developing clinical judgment and interpersonal skills. Hybrid models, integrating both advanced technologies and traditional methods, are likely to become the future standard in surgical education, ensuring that trainees gain both technical expertise and essential experiential learning.

INTRODUCTION

Hepatobiliary surgery is a highly specialized field requiring detailed anatomical knowledge and advanced technical skills. The complexity of procedures such as liver resections, bile duct surgeries, and pancreaticoduodenectomies demands precision, and traditional training methods, including apprenticeship and observation, often fall short in providing comprehensive training[1]. Apprenticeship models often lack standardization, which results in inconsistent teaching and outcomes[2]. Moreover, traditional methods frequently offer limited feedback, making it difficult to assess trainee progress objectively[3]. This gap in effective learning models has led to the integration of technological innovations, such as three-dimensional (3D) modeling, virtual reality (VR), augmented reality (AR), and artificial intelligence (AI), into hepatobiliary surgical education[4-6]. These innovations aim to address the limitations of traditional models by offering immersive, scalable, and interactive learning environments that enhance both cognitive and psychomotor skill development.

The rapid advancement of these technologies has dramatically reshaped how surgeons are trained, providing trainees with the opportunity to practice in controlled, risk-free environments that replicate real-world scenarios[7]. Technologies such as VR, AR, and AI provide opportunities to enhance spatial understanding, improve decision-making, and refine technical skills[8]. This review aims to explore the impact of these technological innovations on hepatobiliary surgical education, assess the challenges faced in their integration, and discuss the potential for these tools to transform surgical training in the future (Table 1).

Table 1 Summary of technological innovations and their impact on hepatobiliary surgery education.

Technology	Key findings	Impact on surgical education
3D modeling and printing	Improves anatomical understanding and visualization. Enhances preoperative planning and allows for interaction with anatomical structures	Provides detailed spatial understanding and aids in surgical planning, leading to better patient outcomes and reduced surgical complications
Virtual reality	Offers immersive, high-fidelity simulations of complex surgeries like liver resections and robotic surgeries	Improves procedural skills, decision-making, and overall surgical competence by providing repeated practice in a risk-free environment
Augmented reality	Enhances intraoperative experience by overlaying digital images or 3D anatomical data on the real surgical field	Enhances visualization, improves decision-making, and reduces errors, particularly in minimally invasive surgeries
Artificial intelligence	Provides real-time feedback and autonomous mentoring. Offers objective performance assessment during simulations	Improves learning efficiency by offering personalized training and identifying areas for improvement in real-time
Haptic feedback	Simulates the tactile sensations of real surgery, such as tissue resistance and pressure during procedures like liver transections	Enhances motor skills and hand-eye coordination, which are essential for performing delicate surgeries with precision

3D: Three-dimensional.

TECHNOLOGICAL INNOVATIONS IN HEPATOBILIARY SURGERY EDUCATION

3D visualization and printing in anatomical education

3D modeling and 3D printing have significantly contributed to the enhancement of anatomical education in hepatobiliary surgery. These technologies allow for a more intuitive and spatially accurate representation of the liver, bile ducts, and surrounding structures, which are often complex and difficult to grasp using traditional two-dimensional imaging methods. Huettl et al[8] and López-López et al[9] showed that the use of immersive VR environments combined with 3D printed models allows trainees to manipulate and interact with anatomical structures in ways that would not be possible with traditional methods. These 3D models help trainees visualize the intricate anatomy of the liver and its variations, which are critical when planning complex surgeries such as liver resections or transplantation.

Additionally, Calle Gómez et al[10] highlighted that the application of 3D printing in surgical planning not only enhances comprehension of anatomy but also contributes to more precise tumor detection and surgical planning, leading to better patient outcomes. Alaimo et al[4] demonstrated that using 3D models in training allows for quicker and more accurate identification of liver lesions and vascular variations, which can be vital in reducing surgical complications. Furthermore, 3D printing provides a tangible model that can be used for simulation-based training, allowing trainees to practice complex surgical tasks such as tumor excision or bile duct reconstruction. Gautam et al[5] found that this tactile experience significantly improved a trainee’s ability to replicate these procedures in real clinical settings.

VR and AR

VR has emerged as one of the most promising tools in surgical education. Gautam et al[5] emphasized that VR provides an immersive learning environment where trainees can practice surgeries repeatedly without the risk of harming patients. VR allows for the simulation of complex hepatobiliary surgeries, where trainees can perform surgeries virtually, making it an effective tool for improving procedural skills, decision-making, and overall surgical competence. Rashidian et al[11] found that VR platforms allow for high-fidelity simulation of liver surgeries, including laparoscopic and robotic approaches, providing a standardized, replicable learning environment. However, it is important to note that VR should be positioned as a complementary tool that enhances learning by providing a controlled, risk-free environment, rather than replacing the experiential component of hands-on practice. The real-world aspects of surgery, such as tissue handling, patient interaction, and clinical judgment, remain irreplaceable for comprehensive surgical training.

AR, on the other hand, enhances the surgical experience by superimposing digital images or 3D anatomical data onto the real-world environment. Cremades Pérez et al[7] noted that AR could be used intraoperatively to assist surgeons in real time by overlaying virtual structures onto the live surgical field, providing enhanced visualization of critical anatomy. This capability is particularly valuable in minimally invasive surgeries, where visual cues are often limited. Xiong et al[12] further demonstrated that AR improves decision-making and reduces surgical errors by providing real-time guidance and improving cognitive understanding of the surgery. Like VR, AR should complement traditional hands-on training, offering an interactive, real-time augmentation of the surgical environment that enhances cognitive and technical skills while maintaining the essential experiential component of surgery. While VR is primarily used in a controlled, simulation-based environment, AR bridges the gap between simulation and real-life surgery, offering an interactive, real-time augmentation of the surgical environment. Jain et al[13] and El-Ashry and Yeung[14] found that AR not only enhances surgical precision but also boosts trainee confidence, especially in complex and high-risk surgeries.

Integration of haptic feedback

Incorporating haptic feedback into VR simulations adds a crucial tactile element that enhances the realism of training. Wu et al[15] and Jie and Yap[16] emphasized that the ability to feel virtual textures and forces during simulations is vital for trainees to develop the fine motor skills required for delicate hepatobiliary procedures. For instance, during liver transection simulations, haptic feedback allows trainees to feel the resistance of the liver tissue and replicate the pressure applied during actual surgery, making the training experience far more realistic than traditional methods.

Azher et al[17] and Allgaier et al[18] found that incorporating haptic feedback into simulations helps trainees develop better hand-eye coordination, as the sense of touch enables them to refine their tactile skills, which are crucial for performing precise liver resections or bile duct surgeries. However, challenges remain in improving the fidelity of haptic devices. Azher et al[17] noted that current devices still face limitations in replicating the full range of tactile sensations that a surgeon would experience in a real surgery, particularly in relation to the nuanced feeling of tissue textures and resistance during dissection.

AI in surgical education

AI is playing an increasingly important role in surgical education by providing real-time feedback, assessment, and autonomous mentoring. Yilmaz et al[19] demonstrated that AI-driven simulation systems offer more objective and immediate feedback on surgical performance compared to traditional human mentors. This allows for personalized training programs, where AI systems identify areas for improvement and suggest tailored exercises to help trainees refine their skills. AI’s role in performance assessment is particularly crucial in large-scale training environments, where expert oversight is limited. Fazlollahi et al[20] found that AI systems capable of analyzing video footage from surgeries or simulations can identify errors and provide instant feedback to trainees, helping them to correct mistakes in real time. Moreover, AI integration with 3D printing has allowed for the creation of customized training models tailored to individual trainees, offering a more personalized and efficient learning experience. However, challenges remain in integrating AI fully into the educational framework. Brian et al[21] cautioned that AI-based systems are still in the experimental stage, and their full potential can only be realized once biases are eliminated and their efficacy in real-world scenarios is validated.

COMPARISONS WITH TRADITIONAL TRAINING MODELS

Traditional training models in hepatobiliary surgery largely rely on an apprenticeship-based system where trainees learn by observing and participating in surgeries under the supervision of experienced surgeons. While this method has been effective in certain contexts, it has limitations in providing consistent and objective feedback. The reliance on a mentor’s subjective evaluation means that the feedback may not be standardized, and trainees may not receive the necessary amount of practice for complex procedures. In contrast, technology-enhanced training models offer several advantages over traditional methods. López-López et al[9] demonstrated that VR, AR, and 3D modeling technologies allow for better anatomical understanding and procedural planning. These tools provide a standardized training environment, ensuring that all trainees are exposed to the same surgical scenarios and receive consistent, objective feedback. Gautam et al[5] and Shen et al[22] also emphasized that simulation-based training accelerates the learning process, as trainees can repeat procedures as often as necessary, thereby gaining more hands-on experience compared to traditional observation-based methods.

Moreover, the use of VR and AR has been shown to significantly shorten the learning curve for complex surgeries by facilitating the rapid acquisition of spatial understanding, decision-making skills, and procedural techniques[2]. This advantage helps trainees progress more quickly, enabling them to perform surgeries with greater confidence and precision. Moreover, Ruff and Pawlik[23] noted that while traditional models are essential for non-technical skills such as communication and teamwork, the lack of objective performance assessment in these models limits their effectiveness in developing technical expertise. In contrast, hybrid models that combine technology with expert oversight seem to offer the best of both worlds, ensuring that trainees gain both technical and non-technical skills while also benefiting from standardized, technology-driven feedback.

CHALLENGES AND FUTURE DIRECTIONS

Despite the promising outcomes of technology-enhanced surgical education, challenges remain in its widespread adoption. Swealem et al[24] pointed out that the high initial costs of VR, AR, and AI systems, coupled with the infrastructure requirements, make it difficult for many institutions, especially those in low-resource settings, to implement these technologies. Furthermore, while many studies demonstrate the effectiveness of these technologies in controlled environments, Mangalote et al[25] and Asoodar et al[26] highlighted that there is still a lack of comprehensive, longitudinal data on the long-term effectiveness and clinical outcomes of technology-based training.

The establishment of immersive learning tools involves significant initial setup costs, including the acquisition of hardware, software, and necessary infrastructure, which can be a barrier for many institutions. However, strategies such as developing low-cost VR platforms, sharing resources among institutions, and seeking funding from educational grants can help mitigate these expenses. These technologies also present potential long-term savings by reducing the need for cadaveric specimens and animal models, as well as enhancing the efficiency of training through repeated practice in a risk-free environment. By decreasing reliance on traditional methods, these technologies not only make training more accessible but also contribute to the overall reduction in training costs over time.

Another significant challenge is the standardization of curricula and assessment metrics. Azher et al[17] noted that the lack of universally accepted protocols for evaluating trainee performance using immersive technologies makes it difficult to compare the effectiveness of different training programs. Standardizing these metrics is essential for validating the effectiveness of new training models and ensuring that they lead to improvements in real-world surgical outcomes. Moreover, Fazlollahi et al[20] raised concerns about the potential for unintended learning outcomes with AI-enhanced curricula. While AI can provide valuable feedback, it is crucial to ensure that it complements human expertise and does not replace it entirely. Yilmaz et al[19] emphasized that AI systems must be validated and continuously monitored by human mentors to ensure that their feedback is appropriate and beneficial for the learner.

CONCLUSION

The integration of technologies such as 3D modeling, VR, AR, AI, and haptic feedback into hepatobiliary surgical education marks a transformative shift in training paradigms. These technologies have proven to be effective in enhancing anatomical comprehension, improving procedural skills, and providing valuable, data-driven feedback to trainees. Despite challenges related to cost, standardization, and long-term validation, these innovations offer substantial promise for improving surgical training outcomes. Further research, particularly in the form of longitudinal, multicenter studies, is necessary to confirm their long-term impact on clinical practice. In the future, a hybrid model combining traditional education methods with advanced technologies may offer the most effective way to train proficient hepatobiliary surgeons, ensuring that they are equipped with the skills and knowledge required to provide optimal patient care.