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TissueDB/Simulators/Open Appendectomy Simulator (Matthews)

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The Matthews Open Appendectomy Simulator (AMPATH Surgical App) is an ultra-low-cost open-appendectomy trainer, built from everyday, locally available materials, for practising all four sections of an open appendectomy in resource-limited surgical training.[1] An eight-layer abdominal-wall analogue (skin, two subcutaneous-fat layers, Scarpa's fascia, the external oblique aponeurosis, the external and internal oblique muscles, and the peritoneum) sits over a glove-based appendix–cecum complex inside a small plastic container. The learner follows the AMPATH Surgical App mobile curriculum to build the model and then practises the operation on it. It was developed by the AMPATH surgical team — a Moi University (Eldoret, Kenya) and Indiana University (Indianapolis, USA) partnership.

Field Details
Features and Basic Operation An eight-layer abdominal-wall analogue over a glove-based appendix–cecum complex in a small plastic container, assembled in about an hour. The trainee opens the abdominal wall, identifies the appendix, ligates the appendiceal artery within the mesoappendix, removes the appendix, and closes the wall — covering all four sections of an open appendectomy.
Current Development Status Built and tested: refined through iterative surgeon and trainee feedback on clarity, utility, and realism; transfer and clinical validity remain future work.
Estimated Build Time and Cost US$1
Specialized Tools and Equipment None — built from everyday materials (a marker draws the muscle-fibre striations during construction) and practised with standard open-surgery instruments.
Version Version 1
Development Team Contact Information AMPATH surgical team — Indiana University (Indianapolis, IN); Moi University and Moi Teaching and Referral Hospital (Eldoret, Kenya); University of South Carolina and Prisma Health (Columbia, SC); and CaseNetwork (Philadelphia, PA). Corresponding author: Manisha B. Bhatia, MD (manishab917@gmail.com).

Tissues

Tissue Qty Material Cost Notes
Skin 1 sheet Vinyl — Outermost surface of the abdominal-wall stack — the skin the trainee opens first.
Subcutaneous Tissue (superficial fat) 1 sheet Polyester Batting (yellow-dyed) — Yellow-dyed batting for the superficial fat plane beneath the skin.
Scarpa's fascia 1 sheet Plastic Wrap — Plastic film between the superficial and deep fat planes; distinct from the peritoneal sheet.
Subcutaneous Tissue (deep fat) 1 sheet Polyester Batting (yellow-dyed) — Yellow-dyed batting for the deep fat plane beneath Scarpa's fascia.
External oblique aponeurosis 1 sheet Cotton Fabric — Cotton fabric standing in for the tough aponeurotic sheet over the external oblique.
Muscle (external oblique) 1 sheet Cotton Batting (cotton-polyester blend) — Cotton-polyester blend batting for the external oblique muscle; its marker-drawn fibre striations run perpendicular to the internal oblique to convey crossing fibre directions.
Muscle (internal oblique) 1 sheet Cotton Batting (cotton-polyester blend) — Cotton-polyester blend batting for the internal oblique muscle; striations run perpendicular to the external oblique.
Peritoneum 1 sheet Plastic Wrap — Plastic film as the innermost sheet of the abdominal-wall analogue.
Cecum 1 Glove + cotton balls — Base of a surgical glove filled with cotton balls, forming the cecum.
Appendix 1 Glove (third finger) — The third (middle) finger of the surgical glove represents the appendix.
Mesoappendix 1 Surgical Mask (scrub-cap material) + Red yarn — Scrub-cap material folded around red yarn, representing the mesoappendix that carries the appendiceal artery.
Appendiceal Artery 1 Red yarn — Red yarn inside the mesoappendix; the ligation target during the appendectomy.
Terminal Ileum 1 Glove (thumb) — Glove thumb representing the terminal ileum at the ileocecal junction.
Tenia coli 1 length Surgical Mask (tie portion) — Tie portion of a surgical mask running from the appendix base to the glove wrist, representing the tenia coli, an anatomical landmark band of the cecum. ⚑ Open for review: linked to the nearest existing class (Muscle); a dedicated Tenia coli class page is a naming/structure decision for Felipe.


Structural Parts

Part Name Qty Material Cost Notes
Plastic container 1 Plastic — Holds the abdominal-wall stack and the appendix–cecum complex; carried over between builds. The plastic container and binder clips are a one-time reusable kit (about US$3), excluded from the per-model build cost.
Binder clips Several Metal — Hold the abdominal-wall stack against the container rim; carried over between builds.
Assembly suture As needed Suture — Used during construction to affix the mesoappendix to the appendix.


Build Instructions

Phase 1: Construct the eight-layer abdominal-wall analogue

Cut each abdominal-wall layer approximately 1 cm larger than the edges of the plastic container (about 20 × 10 × 10 cm) on all sides.

  1. Cut the vinyl skin layer.
  2. Cut a yellow-dyed polyester batting sheet for the superficial subcutaneous-fat layer.
  3. Cut a plastic-wrap sheet for Scarpa's fascia.
  4. Cut a second yellow-dyed polyester batting sheet for the deep subcutaneous-fat layer.
  5. Cut a cotton fabric sheet for the external oblique aponeurosis.
  6. Cut two cotton batting layers for the external oblique and internal oblique muscles.
  7. Use a marker to draw fibre striations on each cotton-batting layer; orient the external oblique striations perpendicular to the internal oblique striations to convey opposing fibre directions.
  8. Cut a second plastic-wrap sheet for the peritoneum.

Phase 2: Construct the appendix-cecum complex

  1. Fill the base of a surgical glove with cotton balls to form the cecum.
  2. Excise the second, fourth, and fifth fingers of the glove (the auxiliary fingers); leave the thumb in place to represent the terminal ileum at the ileocecal junction.
  3. Fold a piece of scrub cap around a length of red yarn to form the mesoappendix containing the appendiceal artery.
  4. Suture the mesoappendix-and-yarn assembly to the third (middle) finger of the glove (the appendix).
  5. Affix a surgical-mask tie from the base of the third finger to the wrist of the glove to represent the tenia coli.

Phase 3: Final assembly

  1. Stack the eight abdominal-wall layers inside the plastic container from deepest to most superficial: peritoneum (plastic wrap) then internal oblique (cotton batting) then external oblique (cotton batting) then external oblique aponeurosis (cotton fabric) then deep fat (polyester batting) then Scarpa's fascia (plastic wrap) then superficial fat (polyester batting) then skin (vinyl).
  2. Secure the layered abdominal wall to the plastic container with binder clips.
  3. Position the appendix-cecum complex inside the container beneath the abdominal-wall analogue, oriented so the appendix can be approached through the open-appendectomy incision.



References

[1]

  1. ↑ 1.0 1.1 Matthews J, Bhatia MB, Thomas C, Okoth P, Martinez CR, Levy JS, Stefanidis D, Hunter-Squires JL, Saruni SI (2022). "AMPATH surgical app: Low-cost simulator for the open appendectomy." Surgery 172(6):1656–1664. DOI: 10.1016/j.surg.2022.07.023. PMID: 36123174. © 2022 Elsevier Inc.




Simulator data
Alternative names AMPATH Surgical App (open appendectomy module); AMPATH Open Appendectomy Simulator



Page data
Keywords open appendectomy, appendectomy simulator, AMPATH Surgical App, Matthews, Indiana University, Moi University, Kenya, low-cost simulator, abdominal wall simulator, glove-based appendix model, resource-limited surgical training, ultra-low-cost simulator
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Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 13 pages link here
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Created May 13, 2026 by Arturo Pelayo
Last edit July 5, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Open Appendectomy Simulator (Matthews)". Appropedia. Retrieved July 15, 2026.
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