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

OBJECTIVE: 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. DESIGN: 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). RESULTS: 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. CONCLUSION: 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.