TissueDB/Simulators/Laparoscopic Appendectomy Simulator (Roche)

The Laparoscopic Appendectomy Simulator (Roche) is a low-cost laparoscopic appendectomy trainer built from castable silicone in a range of shore hardnesses, with a foam cecal core and a button fastener to replicate the tensile properties of different abdominal tissues.^[2] The model sits inside a laparoscopic box trainer and represents the greater omentum, small and large bowel, appendix, mesoappendix and appendicular artery on a firm retroperitoneal base. Learners practise retracting the omentum, mobilising the cecum to isolate the appendix, dividing the mesoappendix, clipping the appendicular artery, placing an endoloop and dividing the appendix. The appendix can be positioned in the normal free-lying, retrocecal or retroileal position.

1. Place modelling clay on a flat surface and stand an 8 mm internal-diameter drinking straw upright in it.
2. In a 500 ml container, mix 10 ml EcoFlex 00-30 Part A, 10 ml Part B, 10 ml THI-VEX thickener, 5 ml red flocking powder and a pinch of red pigment.
3. Fill a 20 ml syringe with the mixture and slowly fill the straw.
4. Allow to set for at least 6 h.
5. Pull the cured silicone tube out of the straw and cut to 100 mm with scissors.
6. Attach a male button to one end with SilPoxy adhesive and allow to set for at least 6 h.

1. In a 500 ml container, mix 100 ml EcoFlex 00-10 Part A, 100 ml Part B and 100 ml Silicone Thinner with 1 drop of light flesh pigment and 1 drop of yellow pigment.
2. Pour onto a flat contained surface and allow to set for at least 6 h.

1. Mix 10 ml SilPoxy with 0.5 drop of red pigment and place into a 10 ml syringe.
2. Press out the material onto the set mesentery sheet to form the main vessel.
3. Remove and safely dispose of the needle; attach an empty 14G cannula to the syringe and extrude finer branch vessels.
4. Allow to set for at least 6 h.

1. In a 1 L container, combine 300 ml EcoFlex 00-10 Part A, 300 ml Part B and 3 ml yellow pigment.
2. Pour onto a flat contained surface and allow to set for at least 6 h.

1. In a container, mix 300 ml EcoFlex 00-10 Part A, 300 ml Part B and 3 ml red pigment.
2. Pour onto a flat contained surface and allow to set for at least 6 h.
3. Cut the set sheet to 600 x 300 mm.
4. Roll into a tube and seal closed with SilPoxy adhesive; allow to set for 6 h.

1. Mix 250 ml EcoFlex 00-10 Part A, 250 ml Part B and 2 ml red pigment.
2. Pour onto a flat contained surface and allow to set for at least 6 h.
3. When set, detach the silicone sheet from the surface; place a 60 mm diameter x 300 mm foam cylinder on it and wrap the sheet loosely around the foam.
4. Seal closed with SilPoxy adhesive; allow to set for 6 h.
5. Attach a female button to the cecum end with SilPoxy adhesive; allow to set for at least 6 h.

1. Using separate syringes, measure 910 ml Mold Max 40 Part A and 90 ml Part B.
2. Combine in a 2 L container with 5 ml red pigment and mix thoroughly.
3. Pour into a tray (approximately 600 x 300 x 30 mm) and allow to set untouched for a minimum of 24 h.

1. Lay incontinence sheets on the work surface and wear personal protective equipment (plastic apron and gloves).
2. Use specifically designated syringes of appropriate volume to draw exact quantities.
3. Remove the base mat from the tray and place on a flat surface in portrait orientation.
4. Place the cecum and ascending colon on the left side of the base mat.
5. Place the small intestine above the appendix area and use SilPoxy to adhere it to the cecum and ascending colon; this junction represents the terminal ileum.
6. Allow to set for at least 6 h.
7. Cut the mesentery sheet to shape.
8. Place the appendix on the mesentery and use SilPoxy to adhere; allow to set for at least 6 h.
9. Attach the male button of the appendix to the female button on the cecum.
10. Place the greater omentum over the entire model.
11. To replace the appendix for a new practice session, detach the button, discard the used appendix, mesoappendix and artery unit, and attach a new one.