What do you mean? In a flight simulator you have your controls controlling a plane (right body, dynamics are well known) in the sky (simple environment, dynamics are reasonably well known, even with different atmospheric conditions like wind). The output is visualized on the screens as a rendering of the scene.
In the case of robotic surgery simulator, you are using the controls to control the arm, but to interact with what? If you just want to move the arm around and maybe interact with some rigid objects sure that's easy. Would that add any training value to the surgeon? Probably not. You can get value only when the simulator includes a simulation of something the surgeon would have to face eventually - organic mass of the human body. Simulating that is hard, and I doubt anyone would invest much into it when you can train surgeons on alternative physical objects like pigs.
Yes, you can produce a model incorporating nonlinear elasticity, viscosity, plasticity, frictional contact, subfailure damage, and fracture / cutting. Repeat for each tissue involved. Some of those methods are well-developed, others are not. Damage and failure in particular is poorly developed, and simulating deformable body contacts can be tricky. Then you have to estimate parameters for all of that, validate that the model produces realistic outcomes, and get it to run in real time.
You can ignore most of the complexity and make approximations, like treating everything as an isotropic linear elastic material, setting cutting resistance to a fixed value per tissue, treating the scalpel like a lightsaber, and accepting that contact will be imperfectly enforced (surfaces may interpenetrate). A crude simulation can still be good enough to be useful as a learning tool though, but it tends to work more like a video game than a true physics-based simulation. We'll still eventually get the kind of accurate simulation you're asking for, probably.
In the case of robotic surgery simulator, you are using the controls to control the arm, but to interact with what? If you just want to move the arm around and maybe interact with some rigid objects sure that's easy. Would that add any training value to the surgeon? Probably not. You can get value only when the simulator includes a simulation of something the surgeon would have to face eventually - organic mass of the human body. Simulating that is hard, and I doubt anyone would invest much into it when you can train surgeons on alternative physical objects like pigs.