The increasing complexity of urological surgery, particularly in minimally invasive surgery (MIS), presents unique challenges for surgical training programs. Mental practice (MP) has gained attention as a potential complement to traditional apprenticeship-based learning. While evidence suggests MP can enhance surgical performance and improve procedural efficiency, it has yet to achieve widespread implementation within training programs. This review and thematic analysis aim to explore key factors for effectively incorporating MP into postgraduate urological surgical training.

A systematic review of Medline, Embase, and PsycINFO databases identified studies examining MP's role in enhancing surgical performance among surgical trainees. Eligible studies involved surgical trainees with prior experience in MIS and included MP interventions. Risk of bias was assessed using standard tools, and a thematic analysis was conducted to identify recurring themes critical for MP’s successful integration into surgical training.

Eleven studies met the inclusion criteria, comprising seven non-randomized and four randomized trials, with sample sizes ranging from 11 to 98 participants. Key themes associated with successful MP implementation were identified: 1. High-quality mental imagery – Achieving vivid mental rehearsal through structured scripts, adjunctive visual models, and targeted support. 2. Relaxation and hypnosis integration – Reducing stress and enhancing receptiveness for mental rehearsal. 3. Motivational imagery – Combining MP with stress reduction techniques to improve surgical confidence. These strategies were shown to improve surgical performance, particularly in reducing cognitive load for junior trainees and enhancing situational awareness for experienced surgeons.

Mental practice is a feasible and cost-effective adjunct to current surgical training, offering both cognitive and performance benefits. Integrating high-quality mental rehearsal with relaxation techniques and motivational imagery has the potential to overcome training limitations and enhance trainee performance in MIS. Future research should focus on translating MP into real-world surgical training, optimizing protocols, and evaluating its long-term impact on patient outcomes and surgical education.