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Open research questions in Surgical Simulation and Training

206 unresolved questions extracted from the limitations and future-work sections of 635 Surgical Simulation and Training papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Heterogeneity in surgical procedures, AI tasks, analytical units, validation strategies, and outcomes. Limited availability of high-quality evidence, with many studies at high or unclear risk of bias. Need for further research to establish the effectiveness of AI in robot-assisted surgery and its potential to improve patient outcomes.

    Applications of artificial intelligence in robot-assisted surgery: a systematic review · 2026 · DOI

  • Heterogeneity in surgical procedures, - Heterogeneity in AI tasks and analytical units, - Heterogeneity in validation strategies and outcomes, - Only one study had low overall risk of bias, - The remaining studies were at high or unclear risk or raised some concerns

    Applications of artificial intelligence in robot-assisted surgery: a systematic review · 2026 · DOI

  • One challenge is the lack of standardized reporting of operative exposure in robot-assisted abdominopelvic surgery. Another challenge is the complexity of cerebral hemodynamics and autoregulation, which can be difficult to measure and interpret. The paper also highlights the challenge of distinguishing between hypoperfusion and hyperperfusion using current monitoring modalities.

    Cerebral hemodynamics, autoregulation, and neurocognitive outcomes during Trendelenburg positioning in robot-assisted abdominopelvic surgery: a narrative review · 2026 · DOI

  • Most studies used different measurement targets, baseline definitions, and observation windows. The value of multimodal monitoring lies in testing whether signals are physiologically coherent. Reporting of operative exposure needs to be standardized. Studies should record the actual table angle, pneumoperitoneum pressure, order in which the exposures were introduced, uninterrupted head-down time, each positional adjustment, and each return toward horizontal.

    Cerebral hemodynamics, autoregulation, and neurocognitive outcomes during Trendelenburg positioning in robot-assisted abdominopelvic surgery: a narrative review · 2026 · DOI

  • The study faced challenges due to clinical heterogeneity, which precluded formal meta-analysis. The paper encountered limitations in the available evidence, including the lack of comparative studies and the dominance of case series and observational cohorts. The study had to address the issue of duplicate reporting and overlapping study populations.

    Beyond da Vinci: a systematic review of next-generation multiport robotic platforms in pediatric surgery · 2026 · DOI

  • Clinical heterogeneity precluded formal meta-analysis, - No randomized controlled trials were identified, - The study is limited to a small number of patients and procedure types

    Beyond da Vinci: a systematic review of next-generation multiport robotic platforms in pediatric surgery · 2026 · DOI

  • Future research that clarifies how such learning occurs, both in and out of the OR, would advance our understanding of sociocultural learning in surgery.

    The dynamics of dialogue: Social interaction, language and culture in intraoperative teaching and learning · 2026 · DOI

  • The lack of binocular depth cues in 2D laparoscopy, which can undermine surgical precision. The need for visuomotor adaptation during the transition from 2D to 3D laparoscopy. The potential for increased cognitive load and decreased surgical performance during the initial adaptation phase.

    A structured learning curve for visuomotor recalibration and surgical performance during transition from two-dimensional to three-dimensional laparoscopic radical cystectomy · 2026 · DOI

  • Single-surgeon study, - Retrospective cohort study, - Limited to a specific type of surgery (laparoscopic radical cystectomy), - No control group for comparison

    A structured learning curve for visuomotor recalibration and surgical performance during transition from two-dimensional to three-dimensional laparoscopic radical cystectomy · 2026 · DOI

  • The study was conducted in a simulated environment, - The sample size was limited to 19 participants due to dropouts, - The study only examined the short-term effects of prismatic loupes, - The selection of surgical specialties was limited to endocrine, head and neck, or vascular surgeries

    Ergonomics and performance of using prismatic loupes in simulated surgical tasks among surgeons – a randomized controlled, cross-over trial · 2024 · DOI

  • The current literature lacks a deep understanding of the role of culture in intraoperative education. More research is needed to explore the relationship between social interaction, language, and culture in the operating room. The paper identifies a need to examine the impact of cultural aspects on learning, well-being, and equity in surgical education.

    The dynamics of dialogue: Social interaction, language and culture in intraoperative teaching and learning · 2026 · DOI

  • Although patient-specific three-dimensional (3D) reconstruction improves anatomical visualisation, standardised methods for incorporating this information into surgical approach selection remain poorly defined.

    Patient-specific three-dimensional planning for surgical approach selection in parapharyngeal space lesions: development of the Vall d’Hebron 3D-PPS Algorithm · 2026 · DOI

  • Augmented reality (AR) systems may improve anatomical visualization and sensory feedback, but their added value compared with mannequin-based simulators and whether perceptions differ according to clinical experience remain uncertain.

    User Experience Comparison of a Traditional Mannequin-Based and an Augmented Reality Lumbar Puncture Simulator in Geriatric Medicine Training: Questionnaire Study · 2026 · DOI

  • While their surgical performance has been widely investigated, limited data exist regarding anesthesiological outcomes.

    Intraoperative outcomes of robotic surgery across multiple multimodal systems · 2026 · DOI

  • There were mixed findings around its impact for improving clinical outcomes given the early system maturity.

    Qualitative perspectives of early surgeon users on the value of the daVinci 5 surgical system · 2026 · DOI

  • Few studies have assessed the value and challenges experienced by surgeons using this new system.

    Qualitative perspectives of early surgeon users on the value of the daVinci 5 surgical system · 2026 · DOI

  • A major limitation to robotic training internationally is sufficient access to console and bedside operating time.

    Development and implementation of the IMRA multiplatform Foundations in Robotic Surgery online learning curriculum · 2026 · DOI

  • In addition, the review highlights areas that warrant further research and explores strategies to address the identified hidden costs.

    The Hidden Cost of Precision: Financial, Training, and Environmental Trade-Offs in Robotic HPB Surgery · 2026 · DOI

  • During early adoption of robotic surgeries, evidence is primarily descriptive, and how such evidence emerges and accumulates over time remains poorly understood.

    Time-series and thematic analyses of clinical utilities and operational issues in early clinical studies of the da Vinci surgical system · 2026 · DOI

  • However, the high costs associated with robotic systems remain a major limitation to their diffusion.

    Exploratory activity-based direct cost analysis of robotic platforms in urologic surgery · 2026 · DOI

  • Robotic surgery training increasingly relies on simulation-based curricula and objective performance metrics; however, it remains unclear whether early simulator performance predicts later proficiency in complex robotic tasks.

    Quality over quantity: early performance predicts suturing proficiency in robotic surgery simulation · 2026 · DOI

  • However, its global research landscape, intellectual base, research hotspots, and thematic evolution remain insufficiently characterized.

    Bibliometric and knowledge-map analysis of research on robot-assisted vascular interventional surgery (2015–2025) · 2026 · DOI

  • INTRODUCTION: Pediatric surgery training in Germany faces significant challenges related to structural issues and resource limitations, including variability in training sites and a lack of standardized oversight.

    Challenges and opportunities in pediatric surgery training in Germany: a view from the trenches · 2025 · DOI

  • Future research should focus on long-term learning curve validation and skill transferability and develop more surgery curricula for generalizability validation.

    An immersive mixed reality surgical self-training system for precise pedicle screw placement: a randomized controlled trial · 2025 · DOI

  • However, it remains unclear whether the teaching effectiveness of face-to-face teaching can be achieved in neurosurgery clinical courses.

    Comparison of face-to-face teaching and online teaching in neurosurgery education for medical students · 2025 · DOI

Most-cited papers in Surgical Simulation and Training

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206 open questions have been extracted from the limitations and future-work passages of 635 Surgical Simulation and Training papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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