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TissueDB/Simulators/Acute Appendicitis Simulator

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Completed appendicitis model showing the appendix, cecum, mesoappendix, and terminal ileum assembled from a vinyl glove and cotton.
Completed Acute Appendicitis Simulation showing the appendix, cecum, mesoappendix, and terminal ileum. Image by ALL-SAFE Consortium; CC BY-SA 4.0.

The Acute Appendicitis Simulator is a low-cost laparoscopic appendectomy trainer built from vinyl exam gloves and other locally available materials for the ALL-SAFE Acute Appendicitis curriculum.[1] The completed model represents the appendix, cecum, mesoappendix, appendiceal artery and terminal ileum. It is secured inside a laparoscopic box trainer for simulated laparoscopic appendectomy.

Field Details
Features and Basic Operation Learners perform a simulated laparoscopic appendectomy on the completed model, including identification and control of the appendiceal artery within the mesoappendix and division of the appendix from the cecum. The module also supports laparoscopic instrument handling and intracorporeal knot-tying practice.
Current Development Status Pilot-tested across four ALL-SAFE sites; preliminary supervised-live evidence from a targeted Mbingo-site sample, not presented as proof of clinical validity.[2][3]
Estimated Build Time and Cost
Not stated in source
Specialized Tools and Equipment For model fabrication, the source requires glove components to be cut but does not identify the cutting implement; an appropriate local cutting tool is therefore required but not source-specified. For training use, a laparoscopic box trainer and laparoscopic instruments are required. Commercial endoloops can be used during the simulated procedure; where these are unavailable, the curriculum teaches a hand-tied Roeder's knot.
Version Version 2
Development Team Contact Information ALL-SAFE Consortium — Pan-African Academy of Christian Surgeons, University of Michigan, Southern Illinois University, Soddo Christian Hospital, AIC Kijabe Hospital, and Mbingo Baptist Hospital — developed under the Global Surgical Training Challenge. Authors of later ALL-SAFE appendectomy research include Grace J. Kim, Department of Surgery, University of Michigan (gracejk@med.umich.edu), and David R. Jeffcoach, Soddo Christian Hospital, Ethiopia.

Tissues

Tissue Qty Material Cost Notes
Appendix 1 Vinyl exam glove finger packed with sand or dirt - The second glove finger is tightly packed with sand or dirt to form the appendix.
Cecum 1 Vinyl exam glove (inverted), filled with cotton or gauze - Forms the cecal pouch to which the appendix is attached.
Mesoappendix 1 Cotton or gauze wrapped in plastic wrap - Forms the simulated mesoappendix surrounding the appendiceal artery. It is divided during the simulated procedure to mobilise the appendix.
Appendiceal artery 1 strand Vessel loop or red yarn - Placed through the mesoappendix to represent the appendiceal artery that the learner identifies and ligates.
Terminal ileum 1 Body of a second vinyl exam glove, with fingers removed - Forms the terminal-ileum landmark adjacent to the cecum and appendix.

Structural Parts

Part Name Qty Material Cost Notes
Silk ties As needed Silk ties - Close the cut and inverted glove components so that their filling remains contained. The build instructions state no gauge.
Tape As needed Wide tape — duct tape or clear plastic tape - Reinforces assembled components and secures the finished model inside the laparoscopic box trainer.

Build Instructions

Have a suitable cutting implement available before beginning. The ALL-SAFE build instructions require glove fingers to be cut but do not identify the tool; no specific cutting-tool type is stated in the source.

Phase 1: Appendix and Cecum

See the Build Instructions PDF and the Construction Video — simulation build for this build.


Diagram of the appendix-cecum complex showing the sand-packed glove finger as the appendix and cotton bulking the cecum.
The appendix-cecum complex: the sand-packed second finger of the vinyl exam glove forms the appendix and cotton bulks the cecum; the red strand is the appendiceal artery added in Phase 2. Image by the ALL-SAFE Consortium, CC BY-SA 4.0.
  1. Take a vinyl exam glove.
  2. Tie off the thumb and third, fourth and fifth fingers using silk ties.
  3. Cut off those tied fingers above the ties.
  4. Invert the glove so that the tied-off portions are inside.
  5. Fill the intact second finger tightly with sand or dirt to form the appendix.
  6. Fill the remaining glove body with cotton balls or gauze to provide bulk for the cecum.

Phase 2: Mesoappendix and appendiceal artery


The appendix-cecum complex with a cotton mesoappendix and an embedded vessel-loop appendiceal artery before plastic-wrap closure.
Phase 2 result — the appendix-cecum complex with the cotton mesoappendix and embedded vessel-loop appendiceal artery, before final plastic-wrap closure. Image by the ALL-SAFE Consortium, CC BY-SA 4.0.
  1. Lay a sheet of plastic wrap on a flat work surface.
  2. Place the appendix-cecum model on the plastic wrap.
  3. Place a layer of cotton or gauze over the model.
  4. Position a vessel loop or red yarn across the cotton layer to represent the appendiceal artery.
  5. Place a second layer of cotton or gauze over the simulated artery.
  6. Fold the plastic wrap around the assembly.
  7. Turn the appendix so that the mesoappendix attaches to its posterior aspect.
  8. Add tape or additional plastic wrap laterally if reinforcement is required.

Phase 3: Terminal ileum


Folded second-glove body, with the fingers removed, being taped to the side of the cecum to form the terminal ileum.
Phase 3 — folded second-glove body, with the fingers removed, taped to the side of the cecum to form the terminal ileum. Image by the ALL-SAFE Consortium, CC BY-SA 4.0.
  1. Take a second vinyl exam glove.
  2. Cut off its fingers.
  3. Fold the remaining glove body in half.
  4. Secure the folded component with tape.
  5. Tape it to the side of the cecum to form the terminal ileum.

Phase 4: Secure the model in the trainer box


Completed model with one edge marked for taping into the box trainer enclosure.
Phase 4 — the completed model with the marked edge secured with wide tape inside the box trainer enclosure. Image by the ALL-SAFE Consortium, CC BY-SA 4.0.
  1. Place the completed tissue model inside the laparoscopic box trainer.
  2. Use wide duct tape or clear plastic tape to secure the model to the base of the trainer.
  3. Keep the tape away from the appendix and cecum so that it does not interfere with the simulated operation.

Phase 5: Endoloops for the procedure

  1. Use commercial endoloops where available.
  2. Where commercial endoloops are unavailable, fashion a Roeder's knot for the simulated procedure.
  3. See the Roeder's knot tutorial video for instructions on forming the knot.
  4. See also the Paradigm Video — expert performing simulated appendectomy and the Tips and Tricks Video — laparoscopic appendectomy.

References

  1. ↑ ALL-SAFE Consortium. ALL-SAFE Acute Appendicitis Simulation Build Instructions. Global Surgical Training Challenge; Pan-African Academy of Christian Surgeons, University of Michigan, Southern Illinois University, Soddo Christian Hospital, AIC Kijabe Hospital, and Mbingo Baptist Hospital, 2022. Build instructions PDF and ALL-SAFE source page. Build-instruction document not indexed in PubMed; primary source linked directly.
  2. ↑ ALL-SAFE Consortium. ALL-SAFE Validation Evidence — Acute Appendicitis module pilot evaluation across four sites; preliminary evidence indicates a targeted sample of learners from the Mbingo site were able to translate learned operative skills to laparoscopic appendectomies in real patients with appropriate supervision, with ratings in the simulated and live environments reported as comparable. Retained as preliminary training-transfer evidence, not proof of clinical validity. Primary project source; not indexed in PubMed.
  3. ↑ Reynolds CW, Rooney DM, Jeffcoach DR, Barnard M, Snell MJ, El-Hayek K, Ngam BN, Bidwell SS, Anidi C, Tanyi J, Yoonhee Ryder C, Kim GJ. "Evidence supporting performance measures of laparoscopic appendectomy through a novel surgical proficiency assessment tool and low-cost laparoscopic training system." Surgical Endoscopy. 2023;37(9):7170–7177. DOI: 10.1007/s00464-023-10182-y. PMID: 37336843. Reynolds et al. (2023) separately evaluated laparoscopic appendectomy performance measures using a low-cost laparoscopic training system; that study is assessment evidence, not the construction authority for this tissue model.
Simulator data
Alternative names ALL-SAFE Acute Appendicitis Simulation; ALL-SAFE Appendectomy Simulator


Page data
Keywords acute appendicitis, laparoscopic appendectomy, appendix, mesoappendix, terminal ileum, appendiceal artery, box trainer, ALL-SAFE, intracorporeal knot tying, low-cost simulator, TissueDB
Authors Arturo Pelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 9 pages link here
Redirects TissueDB/Simulators/Laparoscopic Appendectomy Simulator, TissueDB/Simulators/Laparoscopic Appendectomy Model
Views 39 page views (analytics)
Created May 9, 2026 by Arturo Pelayo
Last edit October 1, 2026 by Arturo Pelayo
Cite as Arturo Pelayo (2026). "TissueDB/Simulators/Acute Appendicitis Simulator". Appropedia. Retrieved October 7, 2026.
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