TissueDB/Simulators/Vascular Anastomosis Simulator (Cubas)

The Cubas Vascular Anastomosis Simulator is a home-made, low-cost, portable training platform for end-to-side (E-T-S), side-to-side (S-T-S), and end-to-end (E-T-E) vascular anastomoses, designed and built by W. Samir Cubas at the Edgardo Rebagliati Martins National Hospital (Lima, Peru) and reported in Cirugía Cardiovascular 29 (2022) 82–88. Total build cost is US$9.75 using commodity hardware (plastic container, crocodile hooks, galvanized wire, curtain-rod chrome brackets, anchor bolts) plus consumable plastic straws as vessel surrogates. The published evaluation was a preliminary n=1 study on a PGY-2 cardiothoracic resident across 273 recorded sessions (4,904 min over six months, June–November 2020), scored with the OSATS-Modified rubric by a single senior-surgeon evaluator.

Assembly is traced to Cubas (2022), "Design, construction, and use" (lines 99–125 of the staged full text). Tools required at build time: pliers and screwdriver (line 101); these are one-off and are not simulator parts. Consumables and instruments required at session time (not part of the frame) are listed in Phase 3.

1. Assemble parts and tools. Parts: 1 × plastic container with lid (30 × 15 × 10 cm); 4 × small crocodile-type hooks; 1 × galvanized fine wire, 20 cm; 4 × chrome curtain-rod brackets; 8 × anchor bolts with nut (5 mm). Tools: pliers, screwdriver (line 101). Consumables for the first session: plastic straws (15 cm × 2–3 mm lumen); 6-0 and 7-0 polypropylene sutures; Castroviejo needle holder; vascular dissection forceps; scissors; scalpel (lines 108–113).
2. Inspect each chrome bracket for a square or clean upper segment capable of accepting a wire loop, and a lower segment compatible with a 5 mm anchor bolt.

1. Cut four equal segments of galvanized fine wire from the 20 cm length (approximately 5 cm per segment, allowing for twisting).
2. For each of the four chrome brackets, loop one wire segment through the bracket's upper segment and through the hinge or rear tab of one crocodile-type hook, then twist the wire closed with pliers until hook and bracket move as a unit. Result: one "fitted part" consists of one hook, one wire binding, and one bracket.
3. Repeat until four identical fitted parts exist. Reference: "the 04 small crocodile-type hooks were joined with each of the 04 upper segments of the chrome-plated supports with the fine galvanized wire" (Cubas 2022, lines 102–104).

1. Position the plastic container on a flat work surface, open, with the lid set aside.
2. Decide the anastomosis modality for the first session. For S-T-S, the four fitted parts couple to the container floor in a parallel arrangement (two parallel rows of two). For E-T-E or E-T-S, the four fitted parts couple perpendicularly (two pairs at right angles to each other). Reference: "placed in parallel in S-T-S anastomoses or perpendicular in E-T-E, and E-T-S" (Cubas 2022, lines 106–107).
3. For each fitted part, pass one 5 mm anchor bolt through the bracket's lower segment and through the container wall or floor at the marked position; secure from the outside with the matching nut, tightened with pliers or screwdriver.
4. After all four fitted parts are bolted, confirm the frame is rigid and that the hooks sit at a consistent height above the container floor. Re-tighten any loose nut.

1. Select two plastic straws (15 cm × 2–3 mm lumen) per anastomosis.
2. For S-T-S: place both straws in parallel, each held along its length by two hooks (lines 114–115).
3. For E-T-S: place one straw between two hooks; hold the second straw by its proximal segment in a third hook, with its distal end oriented perpendicular to the first straw (lines 116–118).
4. For E-T-E: hold each straw by one hook at its proximal portion; orient the two straws end-on with a short gap between them, sufficient for needle-driver access (lines 119–125).
5. Lay out instruments (Castroviejo, forceps, scissors, scalpel) and sutures (6-0, 7-0 polypropylene). Begin the anastomosis.

1. After each recorded session, discard the used straws and any short suture tails.
2. Retain the frame, bolts, hooks, wire bindings, and container for the next session.
3. Note: the source paper does not document a formal cleaning or reset protocol; operators should wipe the hooks and container interior with a laboratory-appropriate surface cleaner per local convention (external to source).

• The plastic container frame is rigid enough to withstand instrument loading during anastomosis practice — pass/fail
• The four chrome brackets are secured by the anchor bolts and do not rotate under load — pass/fail
• Each of the four "fitted parts" (hook + wire binding + bracket) holds the straw without slipping — pass/fail
• The mounted plastic straw is accessible from the working angle used for E-T-S, S-T-S, and E-T-E anastomosis practice — pass/fail
• The rig supports use of Castroviejo needle holder and vascular forceps with 6-0 and 7-0 polypropylene sutures — pass/fail

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