TissueDB/Simulators/Appendectomy Simulator

The Appendectomy Simulator is a low-cost open-appendectomy trainer built from globally available materials.^[1] It places a layered vinyl-and-batting anterior abdominal wall over a procedure-glove appendix–cecum–terminal ileum complex held in a small plastic container. Learners use the completed model to practise the steps of open appendectomy.

Step 1. Using scissors, cut the vinyl skin layer so that it is approximately 1 cm larger than the top of the 10 cm × 10 cm × 20 cm plastic container on all four sides.

Step 2. Use the cut vinyl as the template for the other abdominal-wall layers.

Cut:

• one approximately 1 cm thick polyester-batting layer;
• one approximately 0.5 cm thick polyester-batting layer;
• one cotton-fabric layer;
• two cotton-batting layers; and
• food-grade plastic wrap.

Cut the plastic wrap larger than the other layers because it is trimmed after assembly.

Step 3. Draw diagonal fibre striations on the two cotton-batting muscle layers. Orient the markings in opposing directions.

Step 4. Assemble the abdominal wall from external to internal:

1. vinyl skin, coloured-side-down;
2. thicker polyester batting — subcutaneous fat;
3. one larger plastic-wrap separator — no source-assigned tissue target;
4. thinner polyester batting — fatty tissue;
5. cotton fabric — fascia;
6. first cotton-batting muscle layer;
7. second cotton-batting muscle layer with opposing fibre direction; and
8. two plastic-wrap layers — peritoneum.

Step 5. Place a binder clip on each side to hold the layered wall together.

Step 6. Place one simple interrupted suture in each of the four corners.

Step 7. Trim the excess plastic wrap.

Step 1. Position a procedure glove longitudinally in the plastic container using four binder clips:

• wrist at one end;
• fourth finger at the opposite end;
• fifth finger at one side; and
• second finger toward the opposite end.

Step 2. Tie off the index finger using an instrument tie around a clamp.

Step 3. Suture-ligate the fourth and fifth fingers.

Step 4. Invert the glove so that the tied-off fingers are inside.

Step 5. Thin a piece of cotton to approximately 1 cm thick and the length of the middle finger.

Use a haemostat to place the cotton inside the middle finger. Do not overstuff the distal tip. This forms the appendix.

Step 6. Cut the stocking and a length of yarn approximately 2 cm longer than the middle finger.

Place the yarn inside the stocking and secure one end with a simple interrupted suture. The stocking represents the mesoappendix and the yarn represents the appendiceal vessel.

Step 7. Fold the middle finger into thirds and temporarily hold the ends together with a binder clip on the upper surface.

Step 8. Beginning at the distal tip, run a suture to close the finger edges.

Continue the same suture to attach the stocking along the appendix. Keep the yarn vessel on the side opposite the suture line. Space stitches no more than approximately 0.5 cm apart.

Tie the suture near the base of the finger where it meets the palm.

Step 9. Attach the free end of the stocking on the palm side with a simple interrupted suture near the thumb–palm junction.

Stitch the other stocking end through the stocking and glove and use an instrument tie to create the rounded end of the mesoappendix.

Step 10. Stuff the glove with cotton balls to bulk the cecum and terminal-ileum complex.

Step 11. Cut a surgical-mask tie to the distance from the base of the middle finger to the proximal end of the glove.

Attach it longitudinally with simple interrupted sutures to represent the anterior tenia coli.

• This page records the generic ASAP / AMPATH Surgical App build.
• The source-explicit cost is US$2.97 for reusable components plus US$0.53 per use for disposable components.
• Total build time is not stated.
• Scissors, needle driver and haemostat are source-listed tools.
• Cotton fabric represents Fascia in this generic ASAP build.
• The intermediate plastic-wrap separator between the two fatty layers has no tissue identity assigned by the source.
• Do not import Scarpa's fascia, aponeurosis, cost, dimensions or other recipe details from the separate Matthews appendectomy model.
• RH-005 governs future page/version/fold/navigation treatment; it does not change the source truth of this page.
• No new Structure implementation is introduced by this correction.