TissueDB/Simulators/Intra-abdominal Bleeding Simulator (Fernandes)

The Fernandes Intra-abdominal Bleeding Simulator is a low-cost adult trainer, built from inexpensive, locally available materials, for controlling intra-abdominal haemorrhage from the great abdominal vessels during exploratory laparotomy.^[1] An adult mannequin torso holds silicone organs, fabric-mesh intestines, a fabric peritoneum and an EVA-foam-and-sponge skin layer, with latex tubes for the abdominal vessels. The aorta and vena cava carry simulated blood from one-litre reservoirs; squeezing the arterial bag gives pulsatile flow. The trainee opens the abdomen, identifies the bleeding vessel, controls it by digital compression, and sutures it.

1. Obtain commercial anatomical models of the liver, spleen, stomach, kidneys and pancreas.
2. Immerse each organ in plaster to form a negative mould block.
3. Leave the plaster to dry, then lift out the original anatomical model.
4. Fill each mould cavity with silicone rubber.
5. Cure the silicone, then demould the finished organ.

Verification: Each silicone organ should match the proportions of the original model and demould cleanly.

1. Line the entire back interior of the adult mannequin torso (72 × 54 cm) with a single layer of EVA foam to prevent liquid leaking during simulations.
2. Cut latex tubes (Ref. 203 — 9 mm external, 6 mm internal diameter) to length for each vessel.
3. Position the latex tubes to represent the aorta, vena cava, coeliac trunk, superior and inferior mesenteric arteries, renal arteries and veins, and iliac arteries and veins.
4. Perforate the aorta and the vena cava at anatomically correct positions for the bleeding simulation; the validation scenario used a roughly 2 cm partial section of the aorta at the supramesenteric level.
5. Occlude one end of the aortic tube and connect the other to a one-litre saline bag filled with water and red dye (or artificial blood) through a saline infusion set.
6. Occlude one end of the vena cava tube and connect the other to a one-litre serum bottle that flows under gravity.
7. Position the kidneys and pancreas in the retroperitoneum, fixing them in place with hot glue.

Verification: Compress the arterial bag to confirm pulsatile flow from the aortic perforation, and confirm gravity flow from the vena cava.

1. Lay the semitransparent fabric mesh over the retroperitoneal structures as the peritoneal membrane, separating the peritoneum from the retroperitoneum.
2. Position the peritoneal organs — liver, spleen and stomach — in their anatomical positions, fixing them in place with hot glue.
3. Make the small and large intestines from fine synthetic-fabric mesh in two different colours, each with a little polystyrene microsphere filling, and fix them at the ends only.
4. Place the intestines in the abdomen.
5. Replace the anterior mannequin panel with an EVA-foam plate (72 × 54 cm) carrying a thin sponge layer.

Verification: The peritoneum should show as a semitransparent layer over the retroperitoneal vessels, and the skin layer should allow a laparotomy incision.

• Thoracic haemorrhage — the simulator covers the intra-abdominal cavity only.
• Laparoscopic or minimally invasive procedures in the configuration described — the authors note it could be adapted to a laparoscopic training box with few changes.
• Skills beyond vessel identification, digital compression and hemostatic suturing — these were the skills exercised and assessed in the original validation.

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