TissueDB/Simulators/Bowel Anastomosis Simulator (Habti)
The Bowel Anastomosis Simulator (Habti) is a low-cost trainer for practising hand-sewn small-bowel anastomosis.[1] A 30 cm silicone small-bowel segment with a replicated mucosal surface is cast using a 3D-printed mould and held for suturing in a 3D-printed tabletop clamp called the maxSIMclamp+. A single mould can cast up to four bowel segments.
| Field | Details |
|---|---|
| Features and Basic Operation | A 30 cm silicone bowel segment provides an external wall and replicated mucosal surface for suturing practice. The segment is held between the upper and lower components of the maxSIMclamp+, which attaches to a tabletop or workbench. The development team selected Ecoflex 00-30 after testing silicone formulations of different hardness. Learners reported the simulator as useful for practising hand-sewn bowel anastomosis, while also identifying silicone recoil and tearing as areas for improvement. |
| Current Development Status | Face validity from junior-resident learner assessment (2021); a 2023 randomized trial found skill transfer to an anesthetized porcine bowel model, not validated for human surgery.[2] |
| Estimated Build Time and Cost | CA$35 for the first simulator (includes mould); CA$8 for each additional simulator using the same mould and clamp. Costs are in Canadian dollars (CAD), including local taxes, based on a manufacturing batch of 18 simulators. |
| Specialized Tools and Equipment | FDM 3D printer for fabrication of the reusable mould and maxSIMclamp+; the development team used an Ultimaker S5. The source used Autodesk Fusion 360 during digital model development. Standard suturing instruments are required to use the finished simulator. |
| Version | Version 1 |
| Development Team Contact Information | Co-developed by the maxSIMhealth laboratory at Ontario Tech University and the Department of Surgery / Surgical Oncology Service at Centre Hospitalier de l'Université de Montréal (CHUM), Canada. Lead author: Merieme Habti. Corresponding email reported in the 2023 study: merieme.habti@umontreal.ca. |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Small Intestine | 1 segment; approximately 30 cm long | Castable silicone | CA$8.00 | Approximately 177 g of Ecoflex 00-30 silicone is used per bowel segment. The mould reproduces a mucosal surface. The development team selected Shore 00-30 after testing different silicone hardnesses. Learners and clinicians considered the representation useful for bowel-anastomosis training, although the silicone had greater recoil than biological bowel and could tear during suturing. |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| maxSIMclamp+ | 1 per user/station | PLA | CA$4.80 | 3D-printed tabletop clamp that holds the silicone bowel segment during suturing. It is a reusable station component rather than a bowel-tissue analogue. |
| Bowel mould | 1 | PLA | CA$21.60 | Reusable 3D-printed mould used to cast silicone bowel segments. |
Consumables
| Consumable | Quantity | Material | Approximate Cost | Notes |
|---|---|---|---|---|
| Silicone bowel material | Approximately 177 g per segment | Castable silicone | CA$8.00 | The source uses Ecoflex 00-30. The source identifies the silicone bowel as the consumable component of the simulator. It does not provide a reliable estimate of how many sutures or complete anastomoses one bowel segment can tolerate before replacement. |
Build Instructions
Digital files and provenance
Habti et al. (2021) states that the project digital files were released publicly. The current repository is:
The 10 September 2026 repository inspection found the bowel and clamp/mould STL assets, including the intestine, maxSIMclamp+ and mould components. The repository states that its digital assets are licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International licence (CC BY-NC-SA 4.0).
The repository licence applies to the digital assets. The Habti et al. (2021) Cureus article itself is published under CC BY 4.0.
Phase 1: Print the reusable mould and clamp
- Obtain the development team's STL files from the public maxSIMhealth repository.
- Prepare the files for FDM 3D printing. The development team used an Ultimaker S5.
- Print the reusable bowel mould in PLA. The source reports approximately 720 g of PLA for one mould.
- Print the maxSIMclamp+ components in PLA. The source reports approximately 160 g of PLA for one clamp.
3D-printed bowel mold (720 g, reusable — produces up to 4 silicone bowel segments) and maxSIMclamp+ tabletop clamp (160 g). Printed on Ultimaker S5 using 3D-Fuel Pro PLA (white). The PLA is the mould that casts the bowel, not the bowel itself. See the simulator page for build detail and sources. [1]
Phase 2: Cast the silicone bowel
- Prepare Ecoflex 00-30 silicone according to the manufacturer's mixing instructions.
- Use approximately 177 g of silicone for one 30 cm bowel segment.
- Pour the mixed silicone into the 3D-printed bowel mould.
- Allow the silicone to cure at room temperature.
- Demould the silicone bowel segment after curing.
Timing note: Ecoflex 00-30 manufacturer data gives an approximately 4-hour cure time at room temperature. This is a material cure period only and is not used as the total simulator build time.
One reusable mould can produce up to four bowel segments.
Phase 3: Assemble the simulator
- Place the silicone bowel segment between the upper and lower components of the maxSIMclamp+.
- Secure the clamp assembly using its four latching-style clamps.
- Attach the maxSIMclamp+ to a tabletop or workbench.
- Position the bowel segment for hand-sewn anastomosis practice.
Habti et al. report that learners experienced inconsistent adhesion of the clamp's suction cups on some table surfaces.
Development-stage material variant
Habti et al. (2021) reports that the team was testing a version with power mesh fabric consisting of 80% nylon and 20% spandex embedded during silicone casting to reduce tearing. This was still under development at publication and is not presented as the baseline Version 1 construction.
Known limitations
- The silicone has greater recoil than biological bowel.
- Silicone tearing during suturing was identified as an area for improvement.
- The source did not establish how many sutures or anastomoses one silicone segment can tolerate before replacement.
- Clamp suction cups did not consistently adhere to all table surfaces.
- The 2023 study demonstrated transfer to an anesthetized porcine model; it did not test transfer to human operative performance.
References
- ↑ 1.0 1.1 Habti M, Bénard F, Arutiunian A, Bérubé S, Cadoret D, Meloche-Dumas L, Torres A, Kapralos B, Mercier F, Dubrowski A, Patocskai E. "Development and Learner-Based Assessment of a Novel, Customized, 3D Printed Small Bowel Simulator for Hand-Sewn Anastomosis Training." Cureus. 2021;13(12):e20536. DOI: 10.7759/cureus.20536. PMID: 35070566. CC BY 4.0.
- ↑ Habti M, Bénard F, Meloche-Dumas L, Bérubé S, Cadoret D, Arutiunian A, Papas Y, Torres A, Kapralos B, Mercier F, Dubrowski A, Patocskai E. "Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator." Journal of Surgical Research. 2023;288:225–232. DOI: 10.1016/j.jss.2023.03.004. PMID: 37030179. A single-blinded pilot randomized controlled trial compared two groups of eight junior surgical residents; the experimental group completed eight simulator-practice sessions and improved after practice, maintaining performance between simulator post-test and porcine retention-transfer testing.
Digital Resources
| Authors | Ian-laurel, Arturo Pelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturo Pelayo (2026). "TissueDB/Simulators/Bowel Anastomosis Simulator (Habti)". Appropedia. Retrieved November 10, 2026. |