A low-cost homemade arthroscopic simulator for training triangulation and hand–eye coordination: A technical innovation

Simulator design

The simulator is composed of readily available, low-cost materials ($18–$20) assembled to replicate the core technical challenges of arthroscopy [Figure 1].

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Figure 1:

Low-cost materials used to compose the simulator

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Enclosure

A cardboard box with multiple access ports positioned to simulate standard arthroscopic portals [Figure 2a and b]. Geometric patterns and task designs were drawn on the inner surfaces of the box to support a range of simulation exercises [Figure 3].

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Figure 2:

(a) A cardboard box with holes made to simulate primary arthroscopic portals. (b) Another hole was made to simulate an accessory portal.

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Figure 3:

Patterns are made on the inside of the box to support simulator activities.

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Camera system($8)

A commercially available, low-cost snake camera was used as the visualizing device. Although flexible by design, the camera was converted into a rigid scope by mounting it onto a flat wooden file stick, leaving the camera tip protruding at one end [Figure 4a-d]. The triangular cross-section of the stick facilitated grip and rotational control.

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Figure 4:

(a) A flexible camera is introduced into the rigid file to make it a rigid scope. (b) The camera tip is kept proud of the stick. (c) The mount is reinforced on both ends using adhesive tape. (d) Keeping the camera tip proud enables better reinforcement and visualization.

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Display

A smartphone connected to the camera via the manufacturer’s application served as the display unit, with video recording capability for performance review.

Mounting system($3–$4)

A tripod stand was used to stabilize the smartphone adjacent to the simulator [Figure 5].

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Figure 5:

The camera is connected to a tripod-mounted cellphone, equipped with the required application to view.

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Instruments

• A rigid stick with a curved tip, simulating a probe or titanium elastic nail

• A second stick with a pencil mounted at an angle for advanced precision tasks

• A standard laparoscopic grasper ($10) for object manipulation exercises.

Interchangeable task modules placed within the enclosure allowed simulation of depth perception, targeting, bi-manual coordination, and fine motor control. The simulator was designed to be portable, reproducible, and economical.

Simulator assembly

The cardboard box was placed on a table with the access ports oriented toward the trainee. The camera was introduced through one portal and connected to the smartphone, which was secured on the tripod. The associated application provided real-time visualization and allowed video recording for self-assessment. Instruments were introduced through separate portals to establish triangulation.

Basic skills

The camera was introduced through one portal, and the interior of the box was systematically inspected [Figure 6]. A curved metal rod was introduced through a second portal to perform the following exercises:

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Figure 6:

Inside the box visualized through the camera.

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Instrument localization

Difficulty in locating instruments within the arthroscopic field is common among beginners. Trainees practiced moving the instrument in a plane perpendicular to the camera shaft until contact was made, followed by sliding the instrument along the camera shaft until it entered the visual field [Figure 7]. This maneuver replicated a fundamental arthroscopic technique for instrument acquisition.

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Figure 7:

The instrument is grazed along the shaft towards the camera tip.

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Bi-manual coordination and targeting

Once the instrument tip was visualized, triangulation was established. Trainees practiced maintaining a stable visual field by coordinating camera movement with instrument motion. The instrument tip was used to tap the centers of geometric figures [Figure 8a] and to trace between parallel straight [Figure 8b] and curved lines [Figure 9] to enhance fine motor control and stability.

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Figure 8:

(a) Practice tapping the center of geometrical figures to improve precision. (b) The tip is moved within defined margins to practice hand movement in millimeters and not in centimeters or inches.

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Figure 9:

Some difficult patterns for advanced practice.

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Advanced skills

With increasing proficiency, a pencil-mounted instrument was introduced [Figure 10]. Exercises included filling geometric shapes, writing numbers and letters, and drawing within parallel tracks to improve precision and control.

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Figure 10:

A pencil mounted stick to draw patterns or fill the blank geometrical figures.

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Additional tasks were performed using a laparoscopic grasper, including loose body retrieval (metal nuts), stacking objects, and arranging them into predefined patterns [Figure 11a-c]. These activities simulated common arthroscopic maneuvers such as grasping, probing, and foreign body retrieval.

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Figure 11:

(a) Cheap laparoscopic grasper used to collect scrambled bits of paper and keep them in a defined area. (b) Some more challenging tasks, like stacking up the nuts using graspers. (c) Dual instrumentation can also be practiced by introducing other instruments through the accessory port.

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Advantages

• A) Cost-effectiveness: Provides a low-cost solution for developing skills in arthroscopy

• B) Simplicity: The design is easy to construct, which can be beneficial for institutions or individuals with limited resources.

Disadvantages

• A) Low fidelity: As a low-cost, self-made simulator, the fidelity may be insufficient for replicating more complex or realistic scenarios

• B) Limited scope: Likely lacks some of the advanced features found in more sophisticated simulators.

Lopez et al.^[2] constructed a cost-effective simulator for resident education

Advantages

• A) Valid for training: Demonstrates the validity of cost-effective simulators for educational purposes, which is valuable for residency training.

• B) Realistic task simulations: Focus on creating effective, affordable training for core skills.

Disadvantages

• A) Limited generalization: The construct validity might be confined to specific tasks or types of surgery

• B) Potentially lower fidelity: The focus on cost-effectiveness might compromise the fidelity and realism of the simulation.

Seah et al.^[5] did a study on the VR arthroscopic simulator

Advantages

• A) High-fidelity VR simulator: VR simulators offer immersive experiences that better replicate the feeling of real-life surgery

• B) Efficiency improvement: Training with VR increases efficiency, which is crucial for reducing time to proficiency.

Disadvantages

• A) Limited quantitative skill improvement: While it improves efficiency, VR simulators may not improve all skills equally, especially those that require tactile feedback.

• B) Cost: VR simulators can be expensive, limiting their accessibility to institutions with larger budgets.

Shantz et al.^[8] in their article gave details of building a homemade arthroscopic simulator

Advantages

• A) DIY approach: Provides guidance on creating your own simulator, which can be particularly useful for individuals or institutions with limited resources.

• B) Customization: Users can design simulators that meet their specific needs.

Disadvantages

• A) Time-consuming: Building your own simulator may require significant time and effort, especially if expertise in construction is lacking.

• B) Quality variation: The final product may vary greatly depending on available materials and the builder’s skill.

Lubowitz and Poehling^[9] build a low-cost, low-fidelity, self-made arthroscopic simulator

Advantages

• A) Low-cost solutions: Focus on making arthroscopic training accessible by offering low-cost simulators

• B) Widely applicable: Can be used in various settings, even where funds are limited.

Disadvantages

• A) Low fidelity: As a low-fidelity solution, the simulator may lack essential features (e.g., tactile feedback, realistic visuals) necessary for effective skill development

• B) Not suitable for advanced skills: These simulators are generally not suited for training in more complex or high-level arthroscopic techniques.

Overall, the ideal simulator depends on the context (e.g., budget, training goals, level of experience). Low-cost simulators are beneficial for foundational skills and resource-limited settings, while high-fidelity simulators (such as VR) may offer more immersive and advanced training for complex procedures but come with higher costs.

Compared with previously described low-cost arthroscopic simulators, the present design offers a uniquely economical ($18–$20), portable, and easily reproducible solution while supporting a broader range of progressively challenging psychomotor tasks. By integrating smartphone-based visualization, video recording, and interchangeable task designs within a simple cardboard enclosure, this simulator achieves educational versatility comparable to more expensive models at a substantially lower cost [Table 2].

The simulator described in this report emphasizes core skills, particularly triangulation and hand–eye coordination, that are essential for arthroscopic competence. Enabling repetitive practice outside formal simulation laboratories, such as homemade models, may promote self-directed learning and reduce early technical errors during the transition to live surgical practice.^[8,9]

Limitations

This simulator has several limitations. The camera lacks an angled lens, limiting visualization around corners. Rotation of the camera results in loss of a fixed horizon; unlike standard arthroscopes, the surgeon may face tactile challenges while transferring from this model to a real arthroscope. In addition, this report does not include objective performance metrics or comparative group analysis to quantify skill improvement.