<p>A systematic review on low-cost endoscopic surgical skill simulation training was conducted following PRISMA guidelines, covering studies up to August 31, 2024. Affordable simulators, including cadavers, synthetic materials, 3D-printed models, animal tissues, and virtual reality (VR), are vital for safe skill development, especially in low- and middle-income countries. Cost reduction was achieved through simple designs, reusable components, bulk production, and tele-mentoring. Low-fidelity and do-it-yourself models were effective for basic skills, while collaboration with institutions improved access to resources. Training labs utilized enhanced simulators with features like blood flow, tissue movement, VR, and real-time assessment. Evaluating simulator effectiveness involved factors like precision, procedure time, and user feedback. Regular practice prevented skill decay. Low-fidelity models were suited for early-stage training, while high-fidelity models were used for advanced skill development. Although simulators lacked full realism, they allowed repeatable, stress-free skill development.</p>