The role of simulation in mastering highly specialized pediatric surgery: current trends and future perspectives

The acquisition of surgical skills in highly specialized pediatric surgical procedures - particularly the management of rare congenital anomalies - poses significant educational challenges. Traditional training models relying on apprenticeship and intraoperative exposure are often insufficient due to the rarity and complexity of such conditions. Simulation-based training offers a structured, reproducible, and risk-free environment to practice and refine surgical techniques. This scoping review examines the current landscape of simulation in pediatric surgery, focusing on anorectal malformations (ARM), esophageal atresia (EA), Hirschsprung's disease (HD) and congenital diaphragmatic hernia (CDH). A dual search strategy was applied: a systematic literature search via PubMed and a structured online search via Google for commercially available simulation models. A range of models was identified across the four index conditions, including low-fidelity, high-fidelity, hybrid, and animal tissue-based simulators. EA and CDH showed the highest diversity in simulation tools, supporting both open and minimally invasive approaches. Several of the models we identified have demonstrated face, content and construct validity, but systematic data on learning outcomes and user satisfaction remain scarce. While low-fidelity models are useful for basic skill acquisition, high-fidelity and hybrid simulations more closely replicate the operative environment and enhance decision-making and technical proficiency. However, access to high-fidelity simulators remains limited due to cost and resource constraints. By identifying current limitations and opportunities of simulation training, this scoping review provides insights into how the sustainable training of the next generation of pediatric surgeons can be mastered.