Development and evaluation of the first fully 3D-printed 5-mm laparoscopic grasper for surgical training

Laparoscopic skill acquisition requires extensive training, but the cost of instruments and simulators limits access, particularly in resource-limited settings. Additive manufacturing could provide low-cost, reproducible training instruments, yet fully 3D-printed laparoscopic graspers reproducing standard clinical dimensions have not been reported. We describe the iterative development and bench-trainer evaluation of the Space Child Laparoscopic Grasper (SCLG), the first fully 3D-printed 5-mm laparoscopic grasper.

The SCLG was designed in Fusion 360 and printed from a single photopolymer resin by masked stereolithography. More than twenty prototypes were developed through iterative design-test-redesign cycles. Three bench-trainer evaluation phases compared each SCLG version with a conventional grasper on two tasks (elastic band transfer and peg transfer): feasibility (V1, 16 novices), post-redesign (V2, 37 novices), and expert validation (V3, 10 experienced laparoscopic surgeons). Outcomes were task completion time, object drops, mechanical failures, all-inclusive production cost, and a modified GOALS score. Paired Wilcoxon signed-rank tests were used.

V1 had a 25% mechanical failure rate, 50% of novices reached the time limit, and peg-transfer drops exceeded those with the conventional grasper (7.8 (2.7) vs 2.6 (2.9), p = 0.002). After redesign (V2), no mechanical failures occurred, only 2.7% of novices reached the time limit, and object drops no longer differed significantly. In expert validation, no failures occurred and all surgeons reached the maximum GOALS score (ceiling effect), but completion times remained longer than with the conventional grasper (elastic band transfer: 56.4 vs 33.9 s, p = 0.002; peg transfer: 57.4 vs 42.9 s, p = 0.074); the SCLG was therefore not equivalent. The all-inclusive production cost was approximately €10 per instrument, including €1.50 of resin.

A fully 3D-printed 5-mm laparoscopic grasper is feasible for simulation-based training. Iterative design optimization, without changing the material, markedly improved reliability and performance. Although not equivalent to a conventional grasper, the SCLG's low production cost and reproducibility make it a promising training tool.