title: 3D printing to simulate laparoscopic choledochal surgery.
abstract: OBJECTIVE
  Laparoscopic simulation has transformed skills acquisition for many procedures. However, realistic nonbiological simulators for complex reconstructive surgery are rare. Life-like tactile feedback is particularly difficult to reproduce. Technological innovations may contribute novel solutions to these shortages. We describe a hybrid model, harnessing 3D technology to simulate laparoscopic choledochal surgery for the first time.
  
  
  METHODS
  Digital hepatic anatomy images and standard laparoscopic trainer dimensions were employed to create an entry level laparoscopic choledochal surgery model. The information was fed into a 3D systems project 660pro with visijet pxl core powder to create a free standing liver mold. This included a cuboid portal in which to slot disposable hybrid components representing hepatic and pancreatic ducts and choledochal cyst. The mold was used to create soft silicone replicas with T28 resin and T5 fast catalyst. The model was assessed at a national pediatric surgery training day.
  
  
  RESULTS
  The 10 delegates that trialed the simulation felt that the tactile likeness was good (5.6/10±1.71, 10=like the real thing), was not too complex (6.2/10±1.35; where 1=too simple, 10=too complicated), and generally very useful (7.36/10±1.57, 10=invaluable). 100% stated that they felt they could reproduce this in their own centers, and 100% would recommend this simulation to colleagues.
  
  
  CONCLUSIONS
  Though this first phase choledochal cyst excision simulation requires further development, 3D printing provides a useful means of creating specific and detailed simulations for rare and complex operations with huge potential for development.
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Burdall
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Erica
authors.initials: E
authors.lastname: Makin
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.affiliation: King's College Hospital, London, United Kingdom. Electronic address: adeajayi@doctors.org.uk.
authors.forename: Niyi
authors.initials: N
authors.lastname: Ade-Ajayi
mesh_terms: D002648:Child; D015529:Choledochal Cyst / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008099:Liver / Q000601:surgery; D066330:Printing, Three-Dimensional
keywords: 3-dimensional printing; Choledochal cyst excision; Surgical simulation