How I Do It: Designing A Scalable, Low-Cost Simulation Platform for Global Laparoscopic Training

Expanding access to laparoscopic training in low-resource settings hinges on efforts to create scalable, sustainable, and locally adaptable educational materials. ALL-SAFE was designed to address gaps in laparoscopic surgical education through partnership-driven curriculum development.

ALL-SAFE was guided by 6 pillars of sustainable global surgical partnerships. Modules featured case-based learning and procedural skills training utilizing low-cost simulation. Learners received assessments guided by the Objective Structured Assessment of Technical Skills checklists. Exit surveys evaluating confidence and competence in diagnosis, management, and laparoscopic skills were studied. Open-ended responses were analyzed using the Capability, Opportunity, Motivation-Behavior (COM-B) framework and mapped to the Theoretical Domains Framework (TDF).

From 2021 to 2025, 146 unique learners across multiple geographic settings completed 215 exit surveys upon module completion. Practice time per module ranged from ≤5 hours (52%) to >5 hours (48%). High confidence and competence were reported for diagnosis (76%; 73%) and management (77%; 76%), with lower ratings for laparoscopic skills (42%; 35%). Laparoscopic-skill confidence and competence increased with prior laparoscopic experience (p = 0.003 and p = 0.002), while diagnosis and management did not differ by experience. Qualitative data described improvements in suturing and tissue handling, reduced barriers to practice through a reproducible low-cost model, and aspirations to continue practice and expand minimally invasive surgery locally.

A low-cost simulation platform enhanced confidence and competence in diagnosis, management, and laparoscopic procedural skills across diverse settings. Stakeholder-driven partnerships are essential for creating sustainable surgical education programs in low-resource settings.