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TissueDB/Simulators/Laparoscopic Cholecystectomy Simulator (Casas-Murillo)

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General Information

The Laparoscopic Cholecystectomy Simulator (Casas-Murillo) is a low-cost, in-house built trainer for the dissection and anatomical-recognition steps of laparoscopic cholecystectomy. A silicone-rubber cast of the gallbladder, extrahepatic bile ducts and cystic artery is mounted on hard 3D-printed liver and duodenum scaffolds and dissected through a layered connective-tissue overlay. The published model set covers one normal cystic-duct configuration plus three insertion variants — distal insertion with parallel trajectory, medial middle-third insertion, and medial distal-third insertion — so trainees rehearse the anatomical-variation recognition that governs safe dissection at the hepatic hilum.[1]

Field Details
General Information Clinical procedure: Laparoscopic cholecystectomy, with anatomical-variation training across one normal cystic-duct configuration and three named cystic-duct insertion variants.[1] Target learners: General-surgery residents. It is intended for low-budget residency programs that need affordable, reusable surgical-rehearsal substrates.[1]
Features and Basic Operation What it does: Presents the extrahepatic biliary tree (gallbladder, bile ducts, cystic artery) in surgical position for rehearsal of the dissection and anatomical-recognition steps of laparoscopic cholecystectomy, with anatomical-variation training across one normal and three cystic-duct insertion variants.[1]

How it operates: The silicone biliary cast is mounted on hard 3D-printed liver and duodenum scaffolds inside a metallic box 40 × 30 × 20 cm fitted with three laparoscopic-port openings on the top face and a front port for an endoscopic USB camera that feeds real-time video to a computer monitor; internal lighting illuminates the cavity. The gallbladder is held under tension by a wire that simulates the assistant's retraction maneuver, and layered connective-tissue slime is dissected to expose the cystic duct and cystic artery at the hepatic hilum.[1]

Reusability: The hard 3D-printed Acrylonitrile Butadiene Styrene parts — the liver and duodenum scaffolds and the two-part negative casting molds — are reusable across many casting cycles; only the silicone casts and the connective-tissue slime are per-session expendables, so a single simulator supports repeated practice at low marginal cost.[1]

Operating constraint: The connective-tissue slime must be kept at 25 °C or cooler — at warmer temperatures it melts over the silicone casts and the dissection target is lost.[1]
Current Development Status Single-institution build, peer-reviewed. Designed, built and evaluated at the Universidad Autónoma de Nuevo León and Hospital Universitario "Dr. José E. González", Monterrey, Mexico. Evidence level: expert-reviewed face/content-validity evaluation; not a randomised controlled trial, and the source reports no multi-site replication and no transfer-to-the-operating-room evidence.[1]
Estimated Build Time and Cost Not stated in source.[1], Approximately $20.50 USD per first complete build (2021 USD; sum of Table 1 in the source paper, prices stated natively in US dollars).[1] Approximately $2.20 USD per re-use cycle (silicone for the gallbladder + bile-duct cast and the cystic-artery cast, plus the connective-tissue slime), since the Acrylonitrile Butadiene Styrene two-part negative molds and the 3D-printed liver and duodenum scaffolds are reusable across casting cycles.[1]
Specialized Tools and Equipment Fabrication toolchain (named in the source): a fused-deposition-modeling 3D printer (the source used a Zortrax printer) with Acrylonitrile Butadiene Styrene filament; CAD and segmentation software — 3D Slicer 4.8.0 for DICOM segmentation, Autodesk Meshmixer 3.5.474 for mesh post-processing, and SolidWorks 2016 for the two-part negative mold design; and the source imaging from which the anatomy was derived (magnetic resonance cholangiopancreatography on a 1.5 T scanner for the biliary tree and arterial-phase computed tomography for the liver, duodenum and cystic artery).[1] For use: reusable laparoscopic graspers and an endoscopic USB camera with a computer monitor, mounted in the box chassis.[1]
Version As published in Casas-Murillo et al. (2021). The source describes a single build evaluated between January 2019 and January 2020; no later versions or design iterations are documented.[1]
Development Team Contact Information Developed at the Universidad Autónoma de Nuevo León (UANL) — the Centro de Ingeniería Biomédica, the Radiology and Imaging Department, and the Department of General Surgery of the Facultad de Medicina and Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico. Authors: Casas-Murillo C, Zuñiga-Ruiz A, Lopez-Barron RE, Sanchez-Uresti A, Gogeascoechea-Hernandez A, Muñoz-Maldonado GE, Salinas-Chapa M, Elizondo-Riojas G, Negreros-Osuna AA. Corresponding author: A. A. Negreros-Osuna (adrian.negrerosos@uanl.edu.mx).[1]

Tissues

Tissue Qty Material Cost Notes
Bile Duct 1 (normal + 3 variants) P53 silicone rubber cast in a two-part Acrylonitrile Butadiene Styrene negative mold $0.70 Combined gallbladder + bile-duct cast (Table 1: 26 g, $0.70). Cast continuous with the gallbladder from a two-part negative mold designed in SolidWorks 2016. Covers one normal cystic-duct anatomy plus three variants — distal insertion with parallel trajectory, medial middle-third insertion, and medial distal-third insertion. For the medial-insertion variants the normal anatomical loop around the common bile duct prevents a single complete two-part mold, so the gallbladder + cystic-duct piece is cast separately and joined using the adherent properties of liquefied silicone.[1]
Gallbladder 1 P53 silicone rubber cast continuous with the bile-duct silicone — Cast continuous with the bile duct; cost is combined in the bile-duct row above. Held in position by a wire pulling the gallbladder over the liver scaffold to simulate the assistant's retraction maneuver during real laparoscopic cholecystectomy.[1]
Cystic Artery 1 P53 silicone rubber cast with the right hepatic artery in a separate two-part Acrylonitrile Butadiene Styrene mold $0.30 Cast together with the right hepatic artery (Table 1: 9 g, $0.30). Stapled to the gallbladder; the right hepatic artery is connected to its anatomic insertion in the liver scaffold at the hepatic hilum. No anatomical variants were modeled for this cast.[1]
Connective Tissue Multiple layers (≈142 cc) Elmer's Slime (yellow) applied in layers over the silicone casts $1.20 Layered to represent the hepatoduodenal ligament, the fibrous tissue connecting the gallbladder neck to the liver, and the tissue between the cystic artery and the cystic duct — the material the trainee dissects through. Must be held at 25 °C or cooler or it melts over the casts.[1]


Structural Parts

Part Name Qty Material Cost Notes
Liver scaffold (segments V and VI) 1 Acrylonitrile Butadiene Styrene, 3D-printed on a Zortrax fused-deposition-modeling printer $4.40 53 g. Hard positioning scaffold that holds the silicone biliary cast in surgical position; not a tissue-simulating substrate and not dissected by the trainee — the printed surface is rigid plastic.[1]
Duodenum scaffold (second portion) 1 Acrylonitrile Butadiene Styrene, 3D-printed $0.90 11 g. Hard positional reference for the hepatoduodenal relationship; not a tissue-simulating substrate.[1]
Biliary cast two-part negative mold (normal anatomy) 1 (reusable) Acrylonitrile Butadiene Styrene, 3D-printed from a SolidWorks 2016 design $11.70 140 g. Casts the gallbladder and extrahepatic bile ducts as one continuous silicone piece. The largest single fixture cost; reusable across many casting cycles.[1]
Cystic-artery two-part negative mold 1 (reusable) Acrylonitrile Butadiene Styrene, 3D-printed $1.30 15 g. Reusable across casting cycles.[1]
Simulator chassis 1 Metallic box, 40 × 30 × 20 cm — Not priced in the source. Adapted with three laparoscopic-port openings on the top face and a front hole sized for an endoscopic USB camera.[1]
Endoscopic USB camera 1 Commercial USB camera — Not priced in the source. Real-time intracavity video output to a computer monitor.[1]
Internal lighting 1 unit Commercial — Not priced in the source. Installed inside the chassis for intracavity illumination.[1]
Reusable laparoscopic graspers Set (quantity not stated) Commercial laparoscopic instruments — Not priced in the source. Commercial instruments used for the rehearsed dissection steps; not built.[1]
Screws, wires and staples Set Commodity hardware — Not priced in the source. Screws and wires hold the molds and casts in surgical-relevant position; staples attach the cystic artery to the gallbladder.[1]


Build Instructions

Phase 1: Image acquisition and 3D modelling

  1. Acquire a magnetic resonance cholangiopancreatography study from the radiological archive on a 1.5 T scanner. The source paper used a General Electric SIGNA HDxt LX-MR with an FRFSE-XL pulse sequence, respiration-triggered MRCP ASSET acquisition: 256 slices at 1.4 mm thickness, 0.7 mm interslice gap, field of view 29, matrix 256 × 256, NEX 1, TE 452, TR 3000, acquired on an oblique plane. Select one normal cystic-duct anatomy plus three variant anatomies (distal insertion with parallel trajectory, medial middle-third insertion, medial distal-third insertion).[1]
  2. Acquire an arterial-phase axial computed-tomography study for the liver, duodenum and cystic artery using 1.2 mm slice thickness with 0.635 mm interval.[1]
  3. Segment the DICOM data in 3D Slicer version 4.8.0 and export to STL. Post-process the STL to smooth edges and correct segmentation imperfections in Autodesk Meshmixer 3.5.474. For the liver and duodenum, retain only the organ contours to ease mold assembly and save printing material.[1]

Phase 2: Mold design and 3D printing

  1. Print the hepatic segment V and VI contours and the second portion of the duodenum on a Zortrax fused-deposition-modeling printer in Acrylonitrile Butadiene Styrene filament. Colour the printed replicas after the print finishes.[1]
  2. Design a two-part negative mold for the gallbladder and bile ducts in SolidWorks 2016. Place the gallbladder and bile ducts on the same plane so a straight line can be traced through the centres of the structures — this is what allows the two-part mold to release.[1]
  3. Print the two-part negative molds in Acrylonitrile Butadiene Styrene on the same fused-deposition-modeling printer.[1]
  4. For the medial-insertion cystic-duct variants, separate the negative-mold design into two molds — one for the gallbladder + cystic duct, one for the rest of the extrahepatic bile ducts — because the normal anatomical loop around the common bile duct prevents a single complete two-part mold from releasing cleanly. Attach the two cast pieces after casting (Phase 3).[1]

Phase 3: Silicone casting

  1. Mix P53 silicone rubber with the desired colorant, then pour the mixture into the Acrylonitrile Butadiene Styrene negative mold.[1]
  2. Allow the silicone to solidify, evacuate the silicone replica from the mold, and cleave any asperities caused by silicone flowing out unintentionally.[1]
  3. Cast the cystic artery together with the right hepatic artery in its dedicated two-part Acrylonitrile Butadiene Styrene mold. No anatomical variants are required for this cast.[1]
  4. For the medial-insertion variants, use the adherent properties of liquefied P53 silicone: cast the gallbladder + cystic-duct piece first, then attach it to the bile-ducts mold and apply additional silicone over the join to form a single continuous structure.[1]

Phase 4: Simulator chassis preparation

  1. Adapt a metallic box (40 × 30 × 20 cm) with three laparoscopic-port openings on the top face and a front hole sized for an endoscopic USB camera. Connect the camera to a computer for real-time intracavity video.[1]
  2. Install internal lighting inside the chassis.[1]
  3. Set out reusable laparoscopic graspers and any other instruments needed for the rehearsed steps of laparoscopic cholecystectomy.[1]

Phase 5: Mold assembly inside the simulator

  1. Place the Acrylonitrile Butadiene Styrene liver and duodenum scaffolds inside the chassis. Connect the silicone-cast extrahepatic biliary system to the scaffolds using screws and wires so the structures sit in normal laparoscopic-surgical position.[1]
  2. Pull the gallbladder over the liver using a wire — this simulates the assistant's retraction maneuver during real laparoscopic cholecystectomy.[1]
  3. Staple the cystic artery to the gallbladder. Connect the right hepatic artery to its anatomic insertion in the liver scaffold at the hepatic hilum.[1]

Phase 6: Connective-tissue application

  1. Apply yellow-coloured commercial slime (Elmer's Slime) in layers to simulate (a) the fibrous tissue connecting the gallbladder neck to the liver, (b) the hepatoduodenal ligament, and (c) the tissue between the cystic artery and the cystic duct. The slime is what gives the trainee something to dissect through during the rehearsal.[1]
  2. Verify the workspace temperature is held at 25 °C or cooler before each rehearsal. At warmer temperatures the slime melts over the molds and the dissection target is lost; if the room cannot be held at this temperature, plan for a shorter rehearsal cycle or pre-cool the chassis.[1]



References

[1]

  1. ↑ 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 1.43 1.44 1.45 1.46 1.47 Casas-Murillo C, Zuñiga-Ruiz A, Lopez-Barron RE, Sanchez-Uresti A, Gogeascoechea-Hernandez A, Muñoz-Maldonado GE, Salinas-Chapa M, Elizondo-Riojas G, Negreros-Osuna AA. 3D-printed anatomical models of the cystic duct and its variants, a low-cost solution for an in-house built simulator for laparoscopic surgery training. Surgical and Radiologic Anatomy 2021;43(4):537–544. DOI 10.1007/s00276-020-02631-3. PMID 33386458.




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Authors Arturopelayo
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Language English (en)
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Created May 17, 2026 by Arturo Pelayo
Last edit June 3, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Laparoscopic Cholecystectomy Simulator (Casas-Murillo)". Appropedia. Retrieved June 4, 2026.
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