TissueDB/Simulators/Laparoscopic Box Trainer Simulator

The Laparoscopic Box Simulator gives trainees a low-cost, cardboard-based enclosure for practising basic laparoscopic skills: instrument handling, hand-eye coordination, and trocar placement. The enclosure accepts six interchangeable target tissue modules — ectopic pregnancy, appendectomy, Meckel's diverticulum, penetrating thoracoabdominal trauma, trocar placement, and gallbladder disease. A smartphone mounted on an angled internal stand provides the laparoscopic camera view. The ALL-SAFE Consortium developed the simulator for surgical training in sub-Saharan Africa.

Adapted From

ALL-SAFE Laparoscopic Box Trainer developed by the ALL-SAFE Consortium (Pan-African Academy of Christian Surgeons [PAACS], University of Michigan, Southern Illinois University, Soddo Christian Hospital, AIC Kijabe Hospital, Mbingo Baptist Hospital).

Features / Basic Operation

Low-cost, cardboard-based enclosure that simulates a laparoscopic surgical environment. A smartphone placed inside the box provides a camera view of the working area, allowing trainees to practise instrument handling, hand-eye coordination, and basic laparoscopic skills. Accepts multiple interchangeable target tissue modules (ectopic pregnancy, appendectomy, Meckel's diverticulum, penetrating thoracoabdominal trauma, trocar placement, and gallbladder disease).

Current Development Status

Active — maintained by ALL-SAFE Consortium.

Tool / Fixture	Quantity	Description and Notes	Cost
Box cutter, utility knife, or scalpel	1	For cutting cardboard. #11 blade is suitable but any cutting tool works.	US$5–15
Ruler (12" / 30 cm)	1	Metal suggested for straight cuts.	US$5–10
Pencil	1	For marking cardboard pieces with part letters.	US$1–3
Printer	Access to	For printing cutting templates. A4 or US Letter paper.	$0 (available in most settings)

Download and print these resources before starting:

• PDF of box trainer build instructions (v11.6)
• PDF of measurement templates — draw templates manually
• PDF of templates for A4 paper
• PDF of templates for US Letter paper

Video instructions:

• YouTube: Build instructions
• Vimeo: Platform demo

Print all cutting templates (Parts A, B, C, D, E). Two template files are available: one for A4 paper and one for US Letter paper. Use the file that matches your printer's paper size.

Print settings: 100% scale, no borders or margins. In most situations a small white border will remain on each printed sheet; cut this off to ensure correct dimensions. Tape the pages together to form full-size templates.

Step 1. Use straight pins to secure the paper templates onto the pieces of cardboard.

Step 2. Mark each piece with its corresponding letter (A, B, C, D, E) so it is easier to assemble. Use a box cutter, utility knife, or scalpel and a ruler to cut out each template until you have all six pieces ready to be assembled.

Reference photos: Marking and cutting

Part B (front wall): Cut from a sheet of minimum 8.5" (215 mm) x 14" (355 mm) cardboard. Cut the shape per the template. Cut the slit for Part E insertion. Cut holes by stabbing with a scalpel and rotating. Loop 3 rubber bands together and thread the strand through both holes.

Part D (top): Cut from a sheet of minimum 14" (355 mm) x 10.5" (250 mm). Corrugation direction is important — orient the corrugation front-to-back as shown in the image below. This orientation is required if the Penetrating Trauma target tissue module is to be installed.

Part E (angled phone stand): Cut from a sheet of minimum 8.5" (215 mm) x 14" (355 mm). The centre rectangular cutout can be enlarged for larger phones. Rubber bands placed in the rectangular cutouts at the top of Part E serve as phone retention.

Use tape to attach the two Part A pieces to Part C. The Part A pieces form the sides of the box; Part C forms the back wall. Both Part A pieces must be assembled on the inside of Part C. Tape both the outside and inside corners.

Loop 3 rubber bands together to form a strand and thread the strand through both holes of Part B. Tie the rubber band strand using a normal knot.

Take Part E and place it into the corresponding slits in Part B and Part D. Part E forms the angled work surface; Part B is the front wall; Part D is the top.

Place the side tabs of Part E into the corresponding angled slits in both Part A pieces. Part D sits on top of Part A and Part C. Both Part A pieces attach to the inside of Part B. Tape all pieces together.

Use the phone retention rubber bands to secure a smartphone inside the simulator. Place the phone into the rubber band sling mounted on the angled stand (Part E). This provides a laparoscopic view of the operative field.

Two viewing modes provide different camera angles into the simulator.

Zero-degree (0°) view

For a flat top-down view, place the smartphone flat on Part E with the screen facing the user and the camera pointing into the rectangular cutout. The phone rests against the top lip of Part B. Adjust the smartphone position and the position of the training object until the proper view is acquired.

Thirty-degree (30°) view

For an angled view, stretch the free rubber band hanging from the top of Part E around the smartphone in the vertical direction. Lower the smartphone into the rectangular cutout in Part E. Use the rubber bands attached to Part B to secure the smartphone. Adjust the smartphone position and the position of the training object until the proper view is acquired.

If additional stability is needed, two cardboard flaps anchor the box to the floor or table. Heavy objects placed on the flaps, or tape securing the flaps to the working surface, prevent the box from sliding during use.

1. Cut two slots in the front of the box (Part B). Each slot is approximately 5 mm wide and 40 mm tall, with the two slots 110 mm apart and centered on the front of the box.
2. Cut two slots in the back of the box (Part C). Each slot is approximately 5 mm wide and 40 mm tall, with the two slots 130 mm apart and centered on the back of the box. The wider 130 mm spacing on the back is required if module 3 (Penetrating Trauma) is to be installed later.
3. Cut two new pieces of cardboard, each 192.4 mm × 340 mm (7.57″ × 13.77″). Cut so the cardboard corrugation runs parallel to the 340 mm side; this allows the cardboard to bend along the long edge.
4. Bend each piece 40 mm from one edge.
5. Slide the bent tab of each flap into the corresponding slot pair (front of Part B; back of Part C).
6. Place weights on the flaps, or tape the flaps to the working surface, to prevent the box from sliding during use.