[jpeloquin]

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.

[deelowe]

I was specifically constraining the discussion to robotic surgery. Do all these variables apply in that case?

[jpeloquin]

Not sure how to interpret the question. Using a robot vs. a person doesn't change anything about the physics of how tissue responds to perturbation. You can of course simplify the simulator and correspondingly limit its use to specific learning objectives, probably novice-level. To return to the thread's starting point—we understand flight well enough to make general-purpose flight simulators, we don't understand tissue well enough to make general-purpose surgical simulators. You can still make simple interactive training tools to help someone rehearse the motions of a procedure, but I wouldn't call such a tool a simulator.