Cost-effective Laparoscopic Simulation Models In Surgical Training Programmes For Low- And Middle-income Countries: A Comprehensive Literature Review

Cost-effective Laparoscopic Simulation Models In Surgical Training Programmes For Low- And Middle-income Countries: A Comprehensive Literature Review

Meliska Malla , Bishow Bekhyat Karki, Bikram Thapa, Ashmita Khatri, Prarthana Subedi, Urja Chawal, Vinayak Dhungana, Sulav Katuwal
Chitwan Medical College Teaching Hospital, Chitwan, Nepal; Hull University Teaching Hospital, Hull, United Kingdom; Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, United Kingdom; KIST Medical College and Teaching Hospital, Lalitpur, Nepal; Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal; Chitwan Medical College and Teaching Hospital, Chitwan, Nepal

Introduction: Simulation-based education improves surgical skills; however, it remains underutilised in low- and middle-income countries (LMICs) due to a lack of infrastructure, trained faculty, and high-fidelity simulators. Limited exposure to operating rooms, uneven curricula, and patient safety issues are some of the difficulties facing traditional teaching. Simulation offers a standardised, safe, and useful setting for enhancing abilities and output.

Aim: To evaluate literature on the development, implementation, and challenges of low-cost surgical simulation in LMICs, with an emphasis on laparoscopic training.

Methods: A literature review spanning 2000-2025 was performed to analyse low-cost, low-fidelity surgical simulators in LMICs. Emphasis was put on models using local materials and framing the simulator’s development with educational theories such as Kolb’s Experiential Learning Cycle and Bloom’s Taxonomy to better support skill acquisition and curriculum integration.

Results: Low-cost laparoscopic simulation models enhance the surgical skills and trainee confidence in LMIC. Most of the supporting data comes from pilot studies and short-formatted assessments. Information on long-term skill retention and long-term clinical outcomes is still limited. Key barriers consist of inadequate curricular integration, faculty training, and institutional support. Promising technologies such as telesimulation and 3D printing require further validation and adaptation to specific contexts before widespread implementation.

Conclusion: Low-cost laparoscopic simulation models present pragmatic solutions to enhancing surgical training equity in LMICs. This review highlights the urgent need to develop a systematic approach, based on current evidence, that prioritises long-term skill retention, curricular integration, and institutional facilitation.

Keywords: Low-Cost Simulation, Laparoscopic Training, Surgical Education; Low- and Middle-Income Countries, Global Surgery