TissueDB/Simulators/Intra-abdominal Bleeding Simulator (Fernandes)
General Information
The Fernandes Intra-abdominal Bleeding Simulator is a low-cost, mannequin-based trainer for controlling intra-abdominal haemorrhage during exploratory laparotomy. 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 bags; 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]
| Field | Details |
|---|---|
| General Information | Bleeding can be directed to any chosen vessel by perforating its tube, but only the aorta and vena cava are connected to the blood supply — the other vessels are present for anatomical realism, which keeps the system to a single set of connections and reduces leak points. The simulator is durable and needs little maintenance: over twelve validation runs only the latex tubes and the peritoneal mesh were replaced, twice in total, at about US$4.80 per simulation. It can be adapted to laparoscopic or minimally invasive training with few changes.[1] |
| Features and Basic Operation | The simulator reproduces the abdomen on an adult mannequin torso (72 × 54 cm). Silicone organs cast from plaster moulds of commercial anatomical models form the liver, spleen, stomach, kidneys and pancreas; the small and large intestines are fine synthetic-fabric mesh filled with polystyrene microspheres and coloured differently; a semitransparent fabric-mesh membrane forms the peritoneum; and an EVA-foam plate with a thin sponge layer is the skin layer for the incision. Latex tubes (9 mm external, 6 mm internal diameter) represent the aorta, vena cava, coeliac trunk, mesenteric, renal and iliac vessels. Only the aorta and vena cava carry simulated blood (one-litre bags of water coloured with red dye): the arterial bag is squeezed rhythmically for pulsatile flow, while the venous reservoir flows under gravity. Bleeding can be directed to any chosen vessel by perforating its latex tube.[1] |
| Current Development Status | Assessed by twelve volunteer surgeons, who rated all ten questionnaire items above the authors' acceptance threshold.[1] |
| Estimated Build Time and Cost | Not stated in the source.[1], US$71 (2021) |
| Specialized Tools and Equipment | A hot-glue gun for assembly; plaster (10 kg) and commercial anatomical models of the liver, spleen, stomach, kidneys and pancreas, used to mould and cast the silicone organs; and ballpoint and hydrographic pens, listed among the build materials for adding surface detail to the organs.[1] |
| Version | Not stated in source |
| Development Team Contact Information | Developed by Camila Oliveira Fernandes, Lucas Ribeiro Rodrigues, Mattheus Lucca Batista Silva do Amaral and Sarah Jessica de Morais Rodrigues (Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, SP, Brazil) and Marcos Antonio Marton-Filho (Universidade de São Paulo, Bauru, SP, Brazil). Corresponding author: Marcos Antonio Marton-Filho (marcosmarton@gmail.com). Funded by the PIBIC institutional scholarship programme (Estácio).[1] |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Liver | 1 | Silicone | — | Cast in silicone from a plaster mould of a commercial anatomical model; fixed in position with hot glue.[1] |
| Spleen | 1 | Silicone | — | Cast in silicone from a plaster mould; fixed in position.[1] |
| Stomach | 1 | Silicone | — | Cast in silicone from a plaster mould; a peritoneal organ, placed after the retroperitoneal structures.[1] |
| Kidney | 2 | Silicone | — | Cast in silicone from a plaster mould; placed in the retroperitoneum.[1] |
| Pancreas | 1 | Silicone | — | Cast in silicone from a plaster mould; placed in the retroperitoneum.[1] |
| Small Intestine | 1 | Synthetic fabric mesh + Styrofoam | — | Fine synthetic-fabric mesh with a little polystyrene microsphere filling to stay soft; fixed at the ends only, without mesentery; a different colour from the large bowel.[1] |
| Large Bowel | 1 | Synthetic fabric mesh + Styrofoam | — | Fine synthetic-fabric mesh with polystyrene microsphere filling; fixed at the ends only; a different colour from the small intestine.[1] |
| Peritoneum and Serosa | 1 | Waterproof fabric | — | Semitransparent fabric mesh forming the peritoneum, laid over the retroperitoneal structures so they stay visible.[1] |
| Skin and Subcutaneous Tissue | 1 | EVA Foam + Sponge | — | EVA-foam plate with a thin sponge layer, replacing the anterior mannequin panel; the incision surface for laparotomy access.[1] |
| Aorta | 1 | Latex tube | — | Latex tube (Ref. 203 — 9 mm external, 6 mm internal diameter); the main arterial bleeding vessel, connected to a hand-compressed blood bag for pulsatile flow. The validation scenario used a roughly 2 cm partial section at the supramesenteric level.[1] |
| Inferior Vena Cava | 1 | Latex tube | — | Latex tube (9 mm external, 6 mm internal diameter); the venous bleeding vessel, connected to a gravity-fed reservoir.[1] |
| Non-functional vessels (coeliac trunk, superior and inferior mesenteric, renal and iliac arteries and veins) | 1 set | Latex tube | — | Latex tubes placed at anatomically correct locations for realism; not connected to the blood supply, which keeps the system to a single set of connections and reduces leak points.[1] |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Adult mannequin torso | 1 | Plastic (72 × 54 cm) | — | Base structure; the anterior panel is removed and replaced with the EVA-foam-and-sponge skin layer, and the back interior is lined with a single EVA layer to stop liquid leaking.[1] |
| Reservoir bags (1 litre) | 2 | Saline bag / serum bottle | — | One bag, filled with water and red dye (a simulated-blood substitute), feeds the aorta and is squeezed rhythmically for pulsatile arterial flow; a second one-litre reservoir feeds the vena cava under gravity.[1] |
| IV infusion set | 1 | Standard saline infusion kit | — | Connects the reservoir bags to the latex aorta and vena cava.[1] |
Build Instructions
Phase 1: Make the silicone organs
- Obtain commercial anatomical models of the liver, spleen, stomach, kidneys and pancreas.[1]
- Immerse each organ in plaster (10 kg total) to form a negative mould block.[1]
- Leave the plaster to dry, then lift out the original anatomical model.[1]
- Fill each mould cavity with silicone rubber (about 2 kg of silicone over two batches).[1]
- Cure the silicone, then demould the finished organ.[1]
Verification: Each silicone organ should match the proportions of the original model and demould cleanly.
Phase 2: Prepare the mannequin and place the vessels
- 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.[1]
- Cut latex tubes (Ref. 203 — 9 mm external, 6 mm internal diameter) to length for each vessel.[1]
- 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.[1]
- Perforate the aorta and the vena cava at anatomically correct positions for the bleeding simulation.[1]
- 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.[1]
- Occlude one end of the vena cava tube and connect the other to a one-litre serum bottle that flows under gravity.[1]
- Position the kidneys and pancreas in the retroperitoneum, securing them with hot glue.[1]
Verification: Compress the arterial bag to confirm pulsatile flow from the aortic perforation, and confirm gravity flow from the vena cava.
Phase 3: Final assembly
- Lay the semitransparent fabric mesh over the retroperitoneal structures as the peritoneal membrane, separating the peritoneum from the retroperitoneum.[1]
- Position the peritoneal organs — liver, spleen and stomach — in their anatomical positions, securing them with hot glue.[1]
- 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.[1]
- Place the intestines in the abdomen.[1]
- Replace the anterior mannequin panel with an EVA-foam plate (72 × 54 cm) carrying a thin sponge layer, attached with hot glue.[1]
Verification: The peritoneum should show as a semitransparent layer over the retroperitoneal vessels, and the skin layer should allow a laparotomy incision.
Not suitable for
- Thoracic haemorrhage — the simulator covers the intra-abdominal cavity only.[1]
- Laparoscopic or minimally invasive procedures in the configuration described — the authors note it could be adapted to a laparoscopic training box with few changes.[1]
- Skills beyond vessel identification, digital compression and hemostatic suturing — these were the skills exercised and assessed in the original validation.[1]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 1.40 1.41 1.42 Fernandes CO, Rodrigues LR, Silva do Amaral MLBS, de Morais Rodrigues SJ, Marton-Filho MA. Low-cost simulator for intra-abdominal bleeding. Rev Col Bras Cir 2023;50:e20233512. DOI: 10.1590/0100-6991e-20233512-en. PMID: 37971114. PMC: PMC10618030.
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Intra-abdominal Bleeding Simulator (Fernandes)". Appropedia. Retrieved June 4, 2026. |