Laparoscopic cholecystectomy simulation training: A comprehensive review of models, assessment tools and training...

Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide and serves as a fundamental training operation in general surgery. As surgical education evolves, simulation-based training (SBT) has become an essential component for developing laparoscopic skills outside the operating room. Multiple simulation modalities, such as box trainers, virtual reality (VR), animal models and cadaveric models, are now available to replicate components of LC, each offering distinct benefits and limitations. This narrative review explores the state of LC training with a focus on simulation models, assessment strategies and curriculum structure. We outline the procedural foundations of LC to contextualise key learning objectives. A detailed review of available simulation models follows, highlighting technical features, realism, procedural fidelity and limitations. We also discuss recent advances in model design, including three-dimensional printing and hybrid simulators. Assessment tools used to evaluate LC skills are examined, including global rating scales, procedure-based assessments and hierarchical task analysis-based systems. The shift from traditional case-number-based training to performance-based or proficiency-based curricula is also reviewed, along with the challenges this transition poses. Despite growing evidence supporting SBT, direct comparisons of available LC training models remain limited. Variations exist in fidelity, cost, accessibility and assessment capability across synthetic, VR, animal and cadaveric modalities. This review provides a structured comparison of these training platforms, highlighting their respective strengths, limitations and implications for curriculum design. Understanding of these modalities is essential for optimising training pathways, aligning institutional investment with educational value and ultimately enhancing surgical competency and patient safety.