{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:59:43Z","timestamp":1792789183297,"version":"4.5.0"},"reference-count":23,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Spanish Ministry of Science and Innovation"},{"name":"European Union NextGenerationEU","id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Recovery, Transformation and Resilience Plan","award":["PRTR-C17.I1"],"award-info":[{"award-number":["PRTR-C17.I1"]}]},{"name":"Autonomous Community of Catalonia within the framework of the Biotechnology Plan Applied to Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: This study reports the development and initial face and content validation of high-fidelity 3D hybrid simulators for training in complex pediatric oncologic surgery. Pediatric solid tumor surgery is technically demanding; case volumes are low, and procedural errors carry lifelong oncologic or functional consequences. High-fidelity simulation offers a route to structured training without patient risk. Methods: Patient-derived hybrid simulators were developed by combining 3D-printed anatomical molds with multi-hardness platinum silicone casting. Three oncologic scenarios were reproduced: nephron-sparing surgery (NSS) for Wilms tumor, neuroblastoma L1, and neuroblastoma L2 with major vascular involvement. Retrospective imaging datasets were segmented using Philips IntelliSpace Portal to generate patient-derived STL files. Bony components (simulator box, thoracic wall) were fabricated by selective laser sintering (SLS) in PA12 polyamide. Silicone casting molds were produced by fused filament fabrication (FFF) in basic PLA. Silicone selection (Smooth-On Ecoflex and Dragon Skin series) was based on our team\u2019s expertise in the mechanical characteristics of human organs, matching manufacturer-provided Shore hardness datasheet values to the closest available reference for each tissue type. All components were assembled in anatomically accurate sequence within a patient-sized housing box. Validation was conducted through structured workshops with fifteen pediatric surgical oncologists using a 5-point Likert scale. Results: Mean Likert scores, calculated from participant-level composite domain scores (n = 27 model evaluations from 15 participants), were high across all domains: anatomical accuracy 4.14 \u00b1 0.53 (median 4.00, IQR 3.67\u20134.67), dissection realism 4.29 \u00b1 0.45 (median 4.33, IQR 4.00\u20134.50), and tactile fidelity 4.37 \u00b1 0.56 (median 4.00, IQR 4.00\u20135.00). The L2 neuroblastoma model was rated particularly valuable for rehearsing synchronized two-surgeon workflows and anticipatory communication during high-risk vascular dissection. Conclusions: These hybrid simulators provide a reproducible, high-fidelity platform with strong expert-perceived realism, supporting rehearsal of technical maneuvers and coordinated two-surgeon workflows; formal evaluation of skill acquisition and clinical transfer remains warranted.<\/jats:p>","DOI":"10.3390\/cancers18193135","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:34Z","timestamp":1790589634000},"page":"3135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Initial Validation of High-Fidelity 3D Hybrid Simulators for Training in Complex Pediatric Oncologic Surgery"],"prefix":"10.3390","volume":"18","author":[{"given":"Pamela","family":"Lustig","sequence":"first","affiliation":[{"name":"3D4H Unit, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"},{"name":"Innovaci\u00f3 en Tecnologies Sanitaries, Institut de Recerca Sant Joan de D\u00e9u (IRSJD), Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-3042","authenticated-orcid":false,"given":"Arnau","family":"Valls-Esteve","sequence":"additional","affiliation":[{"name":"3D4H Unit, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"},{"name":"Innovaci\u00f3 en Tecnologies Sanitaries, Institut de Recerca Sant Joan de D\u00e9u (IRSJD), Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Carlos","family":"Alaez","sequence":"additional","affiliation":[{"name":"Simulation Unit, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-9564","authenticated-orcid":false,"given":"Albert","family":"Pasten","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-4488","authenticated-orcid":false,"given":"Lucas","family":"Krauel","sequence":"additional","affiliation":[{"name":"3D4H Unit, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"},{"name":"Pediatric Surgery Department, SJD Barcelona Children\u2019s Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain"},{"name":"Sarcomes i Neuroblastoma, Institut de Recerca Sant Joan de D\u00e9u (IRSJD), Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","unstructured":"Holcomb, G.W., Murphy, J.P., and St Peter, S.D. (2020). Holcomb and Ashcraft\u2019s Pediatric Surgery, Elsevier. [7th ed.]."},{"key":"ref_2","unstructured":"Davidoff, A.M. (2020). Pediatric surgical oncology. Pediatric Surgery, Elsevier. [7th ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/nrurol.2017.163","article-title":"Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol","volume":"14","author":"Hol","year":"2017","journal-title":"Nat. Rev. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100077","DOI":"10.1016\/j.stlm.2022.100077","article-title":"Patient-specific hydrogel phantoms for the preoperative simulation of nephron-sparing surgery in Wilms\u2019 tumor patients: A feasibility study","volume":"8","author":"Fitski","year":"2022","journal-title":"Ann. 3D Print. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"162125","DOI":"10.1016\/j.jpedsurg.2024.162125","article-title":"Nephron-sparing surgery for pediatric renal tumors after centralization of pediatric oncology care in the Netherlands: Improved outcomes with 3D modeling","volume":"60","author":"Fitski","year":"2025","journal-title":"J. Pediatr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/SLA.0b013e31826cbbbd","article-title":"A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: A Children\u2019s Oncology Group study","volume":"256","author":"Nuchtern","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1200\/JCO.2008.16.6876","article-title":"The International Neuroblastoma Risk Group (INRG) staging system: An INRG Task Force report","volume":"27","author":"Monclair","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s00268-015-3295-y","article-title":"Use of 3D prototypes for complex surgical oncologic cases","volume":"40","author":"Krauel","year":"2016","journal-title":"World J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Valls-Esteve, A., Adell-G\u00f3mez, N., Pasten, A., Barber, I., Munuera, J., and Krauel, L. (2023). Exploring the potential of three-dimensional imaging, printing, and modeling in pediatric surgical oncology: A new era of precision surgery. Children, 10.","DOI":"10.3390\/children10050832"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1177\/000313481708300634","article-title":"Workforce issues in pediatric surgery","volume":"83","author":"Nakayama","year":"2017","journal-title":"Am. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1053\/j.sempedsurg.2019.04.014","article-title":"Error traps and culture of safety in pediatric surgical oncology","volume":"28","author":"Krauel","year":"2019","journal-title":"Semin Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Nikitichev, D.I., Patel, P., Avery, J., Robertson, L.J., B\u00fccking, T.M., Aristovich, K.Y., Maneas, E., Desjardins, A.E., and Vercauteren, T. (2018). Patient-specific 3D printed models for education, research and surgical simulation. 3D Printing in Medicine, IntechOpen.","DOI":"10.5772\/intechopen.79667"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jpedsurg.2018.02.016","article-title":"A simulated training model for laparoscopic pyloromyotomy: Is 3D printing the way of the future?","volume":"53","author":"Williams","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_14","first-page":"161985","article-title":"The novel technique for surgical simulation training of patient-specific silicone models of pediatric congenital choledochal cysts","volume":"60","author":"Lu","year":"2025","journal-title":"J. Pediatr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"162144","DOI":"10.1016\/j.jpedsurg.2025.162232","article-title":"Iterative design and manufacturing of a 3D-printed pediatric open and laparoscopic integrated simulator for hernia repair (POLISHeR)","volume":"60","author":"Heo","year":"2025","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"162521","DOI":"10.1016\/j.jpedsurg.2025.162521","article-title":"Design and validation of a low-cost modular simulator for training in neonatal laparotomy and jejunoileal atresia repair","volume":"61","author":"Yeung","year":"2026","journal-title":"J. Pediatr. Surg."},{"key":"ref_17","first-page":"79.e1","article-title":"Low-cost training simulator for open dismembered pyeloplasty: Development and face validation","volume":"16","author":"Rod","year":"2020","journal-title":"J. Pediatr. Urol."},{"key":"ref_18","first-page":"5417","article-title":"Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting","volume":"35","author":"Melnyk","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Valls-Esteve, A., Tejo-Otero, A., Adell-G\u00f3mez, N., Lustig-Gainza, P., Fenollosa-Art\u00e9s, F., Buj-Corral, I., Rubio-Palau, J., Munuera, J., and Krauel, L. (2024). Advanced strategies for the fabrication of multi-material anatomical models of complex pediatric oncologic cases. Bioengineering, 11.","DOI":"10.3390\/bioengineering11010031"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Valls-Esteve, A., Tejo-Otero, A., Lustig-Gainza, P., Buj-Corral, I., Fenollosa-Art\u00e9s, F., Rubio-Palau, J., Barber-Martinez de la Torre, I., Munuera, J., Fondevila, C., and Krauel, L. (2023). Patient-specific 3D printed soft models for liver surgical planning and hands-on training. Gels, 9.","DOI":"10.3390\/gels9040339"},{"key":"ref_21","unstructured":"Maclean, C., Brodie, R., and Nash, D.H. (2019). Proceedings of the Hardness Measurement of Bovine Aorta and Mock Vessel Materials for Endovascular Device Design, British Society for Strain Measurement."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1007\/s10439-016-1757-5","article-title":"Soft 3D-printed phantom of the human kidney with collecting system","volume":"45","author":"Adams","year":"2017","journal-title":"Ann. Biomed. Eng."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"20220354","DOI":"10.1259\/bjr.20220354","article-title":"Promoting simulation-based training in radiology: A homemade phantom for the practice of ultrasound-guided procedures","volume":"95","author":"Giannotti","year":"2022","journal-title":"Br. J. Radiol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3135\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:24:26Z","timestamp":1790742266000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":23,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["cancers18193135"],"URL":"https:\/\/doi.org\/10.3390\/cancers18193135","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}