Journal of Surgical Simulation 2023; 10: 1 - 8

Published: 20 July 2023


Original article

Design and preliminary evaluation of a low-cost laparoscopic training system for use in low-resource settings

Deborah M. Rooney, Melanie Barnard, Nima Keyvan, Arushi P. Mahajan, Daniel Yang, Henry Hilow, Muse Freneh and Grace J. Kim
Corresponding author: Grace J. Kim, 1500 E. Medical Center Drive, SPC 5331, Ann Arbor, MI 48109-5331, USA. Email:


Background: Despite the numerous benefits of laparoscopic surgery over open surgery, the adoption of laparoscopic surgery in low-resource settings has been slow. The lack of effective training models has been identified as the greatest barrier toward implementation of laparoscopy in this setting. We designed a laparoscopic training system which could be built with readily available materials. The aims of this study are to detail the construction of the laparoscopic training system components, to evaluate its ease of build and quality as a laparoscopic training tool, and to evaluate its ability to support completion of targeted tasks, such as salpingostomy and suturing in management of ectopic pregnancy.

Methods: In April 2021, nine participants consisting of four general surgery attendings, three obstetrics/gynecology attendings, and two general surgery residents (1-PGY1 and 1-PGY3) from Ethiopia, Cameroon, Kenya, and the United States constructed and evaluated the laparoscopic training system. Participants evaluated the system using a web-based survey (Qualtrics, Seattle, WA) that queried construction, quality, ability to support performance of critical tasks, and educational value.

Results: The laparoscopic training system was easily built with materials readily available locally and was replicable, sturdy, and realistic. Improvements were made in box dimensions, trocar placement, as well as medium of the ectopic pregnancy based on feedback. The system supported the ability to perform targeted tasks including salpingostomy and placement of a suture ligature and was felt to be a training and testing tool relevant to surgical practice.

Conclusions: Our low-tech, low-cost laparoscopic training system may help to fill the educational gap in the training of laparoscopy in a low-resource setting.


simulation; laparoscopy; low-cost; low-resource; salpingostomy; box trainer

Supplementary material

Supplementary Appendices A–C are available at
Supplementary Appendix A: Build instructions ALL-SAFE laparoscopic box trainer;
Supplementary Appendix B: ALL-SAFE ectopic pregnancy task trainer;
Supplementary Appendix C: Supply list.