White paper for an international Initiative 

Next generation surgical simulation (NGSS)

Why do we need “real” surgical simulation?
Complexity of surgical procedures is rapidly increasing requiring ever more detailed and specialized training for beginners as well as for advanced surgeons. In contrast, decreasing working hours, expectations of a better work-life balance, legal case volume requirements and increasingly patient safety concerns impair traditional surgical training. Therefore, new strategies have to be developed to establish a surgical training that meets the expectations of the 21th century.


What does next generation surgical simulation mean?
Our notion of next generation surgical simulation provides the possibility of performing any surgical procedure using a console like interface together with a high-end computer graphic system. The system is based on a dataset of ultra-high quality medical images comprising the complete human anatomy. Thus, it can be thought of like an artificial human. The the visualization of this dataset is photorealistic and has a resolution that makes the graphic appearance hardly distinguishable from real operations. The whole visualized dataset is interactively manipulable, ssurgical planes, deformability and strength of the tissue as well as bleeding and oozing appear real. Consequently, the simulation is not restricted to specific procedures.


How would it influence surgery?
Training and surgical care (surgical volume) would be unlinked:
- Training would be speeded up enormously
- Intraoperative disasters and troubleshooting could be practiced
- Training at home would be possible if affordable consoles are developed
- Technical training could be delivered during the time of highest motor skills of the surgeon
- Risk of training/career failure would be greatly reduced
- Surgery would be much more attractive for surgeons with families due to better work-life-balance

Reducing risk of surgical innovations
- Entirely new procedures can be developed much more safely and rapidly
- New procedures could be practiced before adoption in routine without any risk


Increasing patient safety
- Taking the operative next step of difficulty at any level of expertise would be much easier and less stressful
- Risks during learning curves of any operation can be largely reduced
- Rare or especially complex operations could be practiced completely or partially before the actual procedure
- Required minimum caseloads could be achieved as simulated procedures to a certain degree
- No training and practicing on patients

- Routine training on body donors could be abandoned. Donors could be reserved for science
and development
Why don´t we have such surgical simulation?
We don´t have a 3D dataset of human surgical anatomy with the resolution and specification
required. For sure, this is an expensive and laborious enterprise. However, the obstacles are not of a
fundamental nature, but rather are a matter of resource allocation. Thus, if the surgical community
convincingly conveys the necessity for this next step in surgical evolution the resources will be
generated. Therefore, the idea of NGSS needs support from as many surgeons as possible.


What are the goals of the NGSS initiative?
Initiation of an international project to create a photorealistic and manipulable 3D-dataset of human
surgical anatomy
Importantly, this dataset should be open resource and be considered as a general human
achievement. This means that everybody, including academic working groups as well as commercial
companies can use the dataset to design different simulation systems and other applications.
Improvement of the dataset should also be an open wiki-like project.
In this way, the work need only be done once and everybody including patients, surgeons, the
healthcare system, and the industry benefits.


Our actions
• Spreading the idea and the goals of our initiative in scientific journals and congresses, as well
as among health care officials
• Contact and convince academic groups working in the field to join a common project
• Convince the healthcare industry to support the project but with a clear commitment for an
open-source policy for the dataset.

What can you do?
• Support our initiative by joining our Facebook group, follow us on Twitter and LinkedIN
• Help us to spread the idea in your personal academic network via your social media
• Consider talks about the initiative when you plan scientific meetings
• Submit papers addressing NGSS
• Place Links of the NGSS Homepage on your institutions website


Photorealistic simulation of complex procedures must be the aim!

Head of pancreas with SMV after dissection for right hemicolectomy with CME