Journal of Surgical Simulation 2020; 7: 33 - 52

Published: 09 March 2021


Review article

Low-cost simulation systems for surgical training: a narrative review

Dhananjaya Sharma, Vikesh Agrawal, Jitin Bajaj and Pawan Agarwal
Corresponding author: Dhananjaya Sharma, Department of Surgery, Government NSCB Medical College, Jabalpur (MP), 482 003, India. Email:


This narrative review appraises low-cost simulation systems for surgical training. Low-cost simulators are needed for minimally invasive and other advanced surgeries because opportunities for practicing the necessary surgical skills using high-fidelity simulation in the workplace are limited due to cost, time and accessibility to junior trainees. A low-cost box simulator can be easily made by self-assembly of components that are available locally or online and even with used, discarded or expired disposable instruments. Skills acquired through low-cost simulations translate into improvements in operating room performance and their efficacy is on a par with expensive systems. A brief comparison of various surgical simulation models, ranging from cadaveric, animal, bench-top, virtual reality, augmented reality to robotic simulators is included in this review. In addition, these low-cost systems can result in significant savings in costs of resident training, as well as in annual running costs of skills labs. Every speciality has developed its own versions of low-cost training systems and has shown their benefits. Low-cost laparoscopic training in 3D is also possible by using visual feedback via the transparent/open top of the box trainer. However, it is important to understand the limitations of a low-cost system. It is a widely available cost-effective workhorse, which can lay the foundation of basic generic surgical skills for younger trainees. Advanced skills can then be easily constructed with high-cost high-fidelity systems.


surgical training; simulation; low-cost; frugal innovation