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

The Intra-abdominal Bleeding Simulator (Fernandes) is a low-cost adult trainer built from an adult mannequin torso, silicone organs, fabric-mesh bowel and peritoneum, EVA foam, sponge and latex-tube vessels for practising control of major intra-abdominal haemorrhage during exploratory laparotomy.^[1] The aorta and inferior vena cava carry simulated blood from one-litre reservoirs. Rhythmic compression of the arterial reservoir produces pulsatile flow, while the venous reservoir flows under gravity. The trainee opens the abdomen, identifies the injured vessel, controls bleeding by direct digital compression and performs hemostatic suturing.

1. Obtain commercial anatomical models of the liver, spleen, stomach, kidneys and pancreas.
2. Isolate each organ model and immerse it in plaster to create a negative mould.
3. Allow the plaster mould to dry.
4. Remove the original anatomical model from the plaster.
5. Fill the resulting mould with silicone rubber.
6. Allow the silicone to cure.
7. Remove the silicone organ from the mould.

Check each demoulded silicone organ for completeness before installation.

1. Use an adult plastic mannequin torso measuring approximately 72 × 54 cm.
2. Cover the entire rear interior of the mannequin with a single layer of EVA material to reduce leakage during simulation.
3. Prepare latex tubing corresponding to Ref. 203, approximately 9 mm external diameter and 6 mm internal diameter.
4. Position tubing to represent the aorta, inferior vena cava, coeliac trunk, superior and inferior mesenteric vessels, renal vessels and iliac vessels.
5. Use the aorta and inferior vena cava as the principal active blood-circuit vessels.
6. Create the required bleeding opening in the selected active vessel. In the validation scenario, the source used an approximately 2 cm partial section of the abdominal aorta at the supramesenteric level.
7. Occlude one end of the aortic tube.
8. Connect its other end through an infusion set to a one-litre saline bag containing simulated blood.
9. Occlude one end of the inferior-vena-cava tube.
10. Connect its other end to a one-litre reservoir that provides flow under gravity.
11. Leave the other abdominal vessel tubes unfilled in the standard configuration.

Before training, check that rhythmic compression of the arterial reservoir produces flow from the selected arterial bleeding point and that the venous reservoir provides gravity-driven flow.

1. Position the silicone kidneys and pancreas in the retroperitoneal region.
2. Fix them in their anatomical positions.

Hot glue and a hot-glue gun are listed among the construction materials; the paper does not specify which structures they secure.

1. Place a fine mesh of semitransparent fabric over the retroperitoneal structures.
2. Use it to represent the peritoneal membrane separating the peritoneal cavity from the retroperitoneum.

The paper separately lists waterproof fabric in its materials-cost table but does not identify it as the semitransparent peritoneal mesh.

1. Position the silicone liver, spleen and stomach in their anatomical locations.
2. Fix the organs in their anatomical positions.

1. Use fine synthetic fabric mesh in different colours for the small and large intestines.
2. Add a small amount of polystyrene microspheres to each bowel representation to preserve softness and malleability.
3. Fix each intestinal representation only at its ends.
4. Do not add a mesentery; the authors intentionally omitted it because it would make manipulation more difficult and increase maintenance requirements.
5. Position the bowel representations in the abdominal cavity.

1. Replace the anterior mannequin panel with an EVA plate measuring approximately 72 × 54 cm.
2. Add a thin sponge layer to the EVA plate.
3. Use this composite as the source-described skin-and-subcutaneous-tissue layer through which the laparotomy incision is made.

Check that the anterior layer permits access to the abdominal cavity and the vessel-control task.

1. Provide appropriate lighting, clothing and standard instruments for exploratory laparotomy.
2. Fill the active reservoir system with simulated blood.
3. In the source validation scenario, create an abdominal-aortic injury with an approximately 2 cm partial section at the supramesenteric level.
4. Begin the scenario with access through the anterior layer and progression to identification of the bleeding point.
5. The learner performs digital compression and prepares the vessel for hemostatic suturing.

• The source configuration is an open exploratory-laparotomy simulator.
• The authors state that it could potentially be adapted to a laparoscopic training box with few modifications, but that adaptation is not the demonstrated build described here.
• The principal evaluated technical tasks were access to the vascular injury, identification of the injured vessel, direct manual compression and hemostatic suturing.
• Transfer of simulator performance to operating-room outcomes was not tested.
• The separately listed waterproof fabric has no source-defined role in the construction narrative.

The source reports US$71 for initial construction in 2021. Maintenance during validation cost approximately US$4.80 per simulated scenario, including minor repairs, replacement of single-use items and consumables.

The twelve-surgeon study assessed anatomical representation, identification and access to the injured vessel, simulated blood pressure, manual compression, hemostatic suturing and the haemorrhage scenario. Agreement ranged from 83.34% to 100% across the questionnaire items. The paper reports differing content-validity cutoffs in its abstract (0.9) and Methods (>0.8). Transfer to operating-room performance was not evaluated.