Precision additive manufacturing for pediatric minimally invasive surgery training in congenital gastrointestinal malformations: technologies, materials, workflow, and future perspectives: a narrative review

Background Pediatric minimally invasive surgery (MIS) simulators for congenital gastrointestinal malformations is technically demanding because of limited operative space, delicate tissues, and the rarity of these conditions. Consequently, opportunities for structured skills acquisition remain scarce, creating a need for realistic and reproducible simulation platforms. Precision additive manufacturing offers new possibilities for developing high-fidelity surgical simulators tailored to pediatric procedures. Methods A structured narrative review was conducted. PRISMA 2020 reporting principles were used solely to improve transparency in study identification, screening, eligibility assessment, and inclusion; the review was not designed as a systematic or scoping review. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for studies addressing additive manufacturing technologies, tissue-mimicking materials, pediatric MIS simulation, congenital gastrointestinal malformations, and simulator validation. Three authors screened records and extracted data collaboratively using predefined criteria and a standardized framework. Relevant evidence was synthesized narratively. Results Forty-six studies were included. Current evidence demonstrates that additive manufacturing enables anatomically accurate, reproducible, and increasingly patient-specific simulators. Hybrid approaches combining high-resolution 3D printing with silicone or other tissue-mimicking materials provide a favorable compromise between realism, durability, and cost. Pathology-specific simulators, particularly for esophageal atresia with tracheoesophageal fistula, have shown encouraging face, content, and construct validity, with improvements in technical performance following simulation-based training. However, objective assessment metrics, transfer validity, and multicenter validation remain limited. Conclusions Precision additive manufacturing represents a promising strategy for pediatric MIS education. Future efforts should focus on improved tissue realism, objective performance assessment, standardized validation frameworks, and demonstration of transfer of skills to clinical practice to support safer and more effective surgical training.