A systematic review of low-cost laparoscopic simulators

Abstract

BackgroundOpportunities for surgical skills practice using high-fidelity simulation in the workplace are limited due to cost, time and geographical constraints, and accessibility to junior trainees. An alternative is needed to practise laparoscopic skills at home. Our objective was to undertake a systematic review of low-cost laparoscopic simulators.MethodA systematic review was undertaken according to PRISMA guidelines. MEDLINE/EMBASE was searched for articles between 1990 and 2014. We included articles describing portable and low-cost laparoscopic simulators that were ready-made or suitable for assembly; articles not in English, with inadequate descriptions of the simulator, and costs >£1500 were excluded. Validation, equipment needed, cost, and ease of assembly were examined.ResultsSeventy-three unique simulators were identified (60 non-commercial, 13 commercial); 55 % (33) of non-commercial trainers were subject to at least one type of validation compared with 92 % (12) of commercial trainers. Commercial simulators had better face validation compared with non-commercial. The cost ranged from £3 to £216 for non-commercial and £60 to £1007 for commercial simulators. Key components of simulator construction were identified as abdominal cavity and wall, port site, light source, visualisation, and camera monitor. Laptop computers were prerequisite where direct vision was not used. Non-commercial models commonly utilised retail off-the-shelf components, which allowed reduction in costs and greater ease of construction.ConclusionThe models described provide simple and affordable options for self-assembly, although a significant proportion have not been subject to any validation. Portable simulators may be the most equitable solution to allow regular basic skills practice (e.g. suturing, knot-tying) for junior surgical trainees.

Disseminating technology in global surgery

“…In a recent systematic review, Chao and colleagues described several adaptive strategies to enhance the adoption of laparoscopic surgery in LMICs. These included infrastructure and system innovations, such as soft drink companies providing carbon dioxide, sunlight as a light source, and low‐cost box trainers for surgical training. Price et al .…”

Multi-institutional Evaluation of Producing and Testing a Novel 3D-Printed Laparoscopic Trainer

“…The UCiT overcomes the deterrents to laparoscopic training due to UCiT's low cost, easy assembly, and storage, and UCiT's 24/7 availabilIty. 7,16,17 The UCiT empowers residents to train in a setting of their choosing whether UCiT be at work or at home. Other low-cost, novel laparoscopic trainers have also been developed; however, the UCiT device is unique as it could be printed and assembled in four distinct geographical areas (Manila, Philippines, Rome, Italy, Modena, Italy and New Hyde Park, NY, USA).…”

“…Other low-cost, novel laparoscopic trainers have also been developed; however, the UCiT device is unique as it could be printed and assembled in four distinct geographical areas (Manila, Philippines, Rome, Italy, Modena, Italy and New Hyde Park, NY, USA). 17 Furthermore, the cost of the materials required to assemble a functional UCiT is marginal ($26.50 USD). However, if the department does not possess a basic entry level 3D printer, the files are in standardized file format (stereolithography, STL) and any 3D printer with a minimum printing bed of 8 £ 5 inches (over 90% of 3D printers on the market meet this requirement) could be used.…”

A laparoszkópos készségfejlesztés eszközei – elérhető trénerek és szimulátorok

“…A minimálisan invazív sebészethez (MIS) szükséges koordinációs készségek nagymértékben eltérnek a nyitott műtéteknél szükségesektől. A kétdi-menziós rendszereknél a kamerával történő navigációnál a síkképernyő miatt lecsökken a mélységérzékelés, és a ÖSSZEFOGLALÓ KÖZLEMÉNY tapintásból nyert információ is elvész [2]. A megfelelő ügyesség kifejlesztéséhez egy jól definiálható tanulási görbe társul, amelyen a hagyományos sebészetben alkalmazott oktatási módszerek -beleértve az állatokon vagy humán cadaveren történő gyakorlást -nem tudják költ-séghatékonyan és ugyanakkor kockázatmentesen végig-vezetni a tanulókat [3,4].…”

“…A szakirodalom több, nagyon alacsony költségű, nem forgalomban lévő, prototípusjelle-gű megoldásra rámutat, amelyek könnyen megépíthetők, viszont ezek az eszközök értelemszerűen semmilyen validáláson nem estek át, így praktikusságukkal szembehelyezkedik oktatási értékük kétségbe vonhatósága [2]. A boksztrénerek általában egyszerűbb felépítésűek, hordozhatók, és az alapvető laparoszkópos készségek fejlesztését teszik lehetővé.…”