ALL SAFE Laparoscopic Box Trainer

This page describes the instructions for building the ALL-SAFE laparoscopic box. This is a test derivative of ALL-SAFE's original documentation. To follow instructions, review instructions for its components.

This curriculum is designed to be used in the context of other laparoscopic surgical training activities.

This simulator is designed for medical professionals who have completed, or are in the process of completing their surgical training, and know how to perform the open surgery equivalent of procedures taught on this site.

The simulator provides a realistic yet low-cost environment to practice the cognitive and psychomotor skills essential for laparoscopic surgery. This is why the following learning objectives were established:

• To improve the surgeons' confidence and competence in the laparoscopic management of basic surgical conditions
• To support the development of basic cognitive and technical skills required for the safe laparoscopic management of basic surgical conditions
• To provide surgeons with standardized educational content on the laparoscopic management of basic surgical conditions to assist in development of relevant clinical judgment
• To provide a formative assessment framework and objective quantifiable measures to assess knowledge, judgment, and manual skills in the laparoscopic management of basic surgical conditions
• To promote collaboration between countries of diverse resource levels to provide a low-cost, open source, portable educational and assessment framework to improve quality of surgical care

The laparoscopic box trainer is a portable, low-cost enclosure that replicates the constraints and ergonomics of laparoscopic surgery.

• Hands-on practice: Real laparoscopic instruments are inserted through trocar-like ports.
• Visual fidelity: A camera transmits a 2D video image to a monitor, mimicking real laparoscopic visualization.
• Fulcrum effect: The design reproduces the reversed motion experienced in laparoscopic procedures.
• Progressive learning: Exercises increase in complexity, allowing gradual skill building.

The simulator is scalable and adaptable, supporting both individual learners and structured group training courses.

This simulator can be used repeatedly without major recurring costs.

• A durable cardboard box trainer can last several months to over a year with reinforcement and proper care.
• Target tissue consumables can be fabricated locally from low-cost materials and replaced as needed.
• Avoid contamination with organic fluids.

The ALL-SAFE simulator and training course have been piloted and tested with surgical trainees in multiple LMIC settings. Due to its success, the West African College of Surgeons (WACS) formally adopted ALL-SAFE as its primary laparoscopic training platform, making it a required component in affiliated training sites.

The simulator continues to expand internationally as part of efforts to reduce barriers to laparoscopic training in resource-limited regions.

Benefits:

• Very low cost and high accessibility.
• Compatible with real laparoscopic instruments.
• Effective for acquiring core laparoscopic skills.
• Portable, lightweight, and adaptable to different training contexts.

Limitations:

• Limited anatomical realism (no organ or tissue simulation unless add-ons are incorporated).
• No simulation of bleeding, insufflation, or haptic feedback.
• Best suited for skills training rather than full procedural replication.

Building the simulator enclosure (laparoscopic box) usually takes less than three hours. While the cost may vary by country, it can be fabricated for under $100 USD.

• Original design: ALL-SAFE Consortium (2021).
• Documentation: Adaptation by industrial designer Andrea Robredo Cernicchiaro (last update: September 2025).

• Simulator development and documentation: ALL-SAFE Consortium (2021)
• For additional resources and build details: ALL-SAFE