Introduction: Laparoscopic Surgery Simulator

During this pandemic front line healthcare staff have redirected much of their time and man power to supporting the A&E, medical wards and ICU.

For surgeons, much of the surgical work has been whittled down to emergency and urgent work. We have stopped laparoscopic (key hole) operating for safety reasons. Training for juniors has ceased as we switch to a service provision role. But surgery is a skill that still requires practice like any physical skill. To enable our juniors to keep practicing their laparoscopic skills in between the on calls and ICU shifts and also to keep their morale up performing the skills they love - we have created a simple box trainer with minimal equipment and utilising their phones as camera, screen and light source. It is a cheap set up which we can leave in our office space which can be used without a camera assistant. The cheap set up can be taken anywhere, be built with minimal equipment and is largely recyclable!

After construction we suggest running a virtual tournament (which, of course, observes social distancing) where competitors will film themselves performing skills and send to "judges" via WhatsApp.

Happy practicing and stay safe

P Zarsadias, Sarah Iqbal, Anang Pangeni, Samip Prakash, Andrea Hanu

General Surgical Department, William Harvey Hospital, East Kent University Hospitals Foundation Trust


Card board box - larger than a medium sized human torso
Box cutter
Ruler/Measuring tape
Laparoscopic instruments
Adhesive/Tape (optional)
Liner paper (optional)

For suggested skills exercises-
Sugar cubes
Matches and Styrofoam
Polo mints
Disposable glove/balloon
Suture material
Two layers of plastic, one with a circle drawn on it

For suggested upgrade:
Web camera
Computer and monitor to stream to

Step 1: Mark Out Your Cuts and Folds

Take your cardboard box and lay it on its side with the opening toward the side. Left or right, makes no difference. If it's not a cube lay it "on its back" as if it were a torso.

Mark the halfway point on the edge of the box.

Make a mark 9cm either side of the midpoint on the edge of the box. From these two marks- measure 10cm from the edge inward on the upper face of the box and 5cm down the side of the box. Join up the dots as per the picture.

Step 2: Mark Out and Cut Windows

Make two windows on the 10*18cm rectangle. We would recommend taking a couple of colleagues smart phones and approximate the size of the windows to allow the cameras to see into the box.

Leave as large a margin between the side of the rectangle and the window to ensure structural integrity.

Cut your windows carefully with a box cutter.

Step 3: Cut and Push

With the box cutter score the lines parallel to the box edge. Cut the lines perpendicular to the edge.

Gently push the edge of the box to invert the shape to form the phone cradle.

Mark two access port for instruments either side of the phone cradle. Cut an X with the box cutter at these marks and push a pen through to make holes.

Step 4: Wrap and Line the Box (optional)

With whatever lining material you have handy you can make your box look more professional. We used some wallpaper liner and added a torso. However, if you opt for the torso we would recommend you rotate the position of the torso 90degrees from the position you see in our pic. We very rarely operate positioned on a patient's lap.

When wrapping the box do not close the opening of the box. This will serve as an access point for inserting objects into the box as well as allow ambient light to enter.

To improve the lighting without having to resort to another light source you can line the inside of the box with white coloured paper.

Step 5: Start Practicing!

Place your phone in the cradle with the video and camera light on.

You're ready to start practicing!

Classic low tech exercises to start with:
1. Stack sugar cubes
2. Place polo mints on pegs (matches stuck into Styrofoam)
3. Transfer polos between instruments
4. Place endoloops around a balloon or disposable glove
5. Cut a circle precisely without cutting the layer beneath it.

Step 6: Make It More Challenging (optional)

The set up described above is perfect for junior colleagues as a starting point as you are manipulating the instruments in the same direction as you are looking with the screen.

To simulate operating more accurately we would recommend replacing the phone with a web camera streaming to a monitor positioned up and toward the side. This is a far more realistic position to operate in with your head up and slightly angled from the direction of operating which can pose a challenge for early years trainees.

Cardboard Speed Challenge

Participated in the
Cardboard Speed Challenge