TissueDB/Simulators/Trocar Placement Simulator

The Trocar Placement Simulator is a low-cost laparoscopic trocar-placement training module built from locally available materials (cardboard, plastic wrap, felt, sponge and balloons) for practising trocar placement through a layered model of the abdominal wall.^[2] The module mounts on a laparoscopic box trainer; layered materials stand in for skin, adipose tissue, fascia, muscle and peritoneum, with a small balloon as the umbilicus and an inflated modeling balloon — coloured on both sides with red lipstick — as the bowel beneath the peritoneum. A cell phone mounted above the module with a rubber band provides the trainee's overhead camera view.

Build Instructions PDF (source document)

Step 1. Cut a piece of cardboard to 10.16 cm × 56 cm (4 × 22 in). Orient the cardboard corrugation as shown — this affects folding behavior.

Step 2. Follow the cutting template: cut two slots 2.54 cm (1 in) from each edge. Slot length should be half the 10.16 cm (4 in) dimension.

Step 3. Mark fold points at the dashed lines in the template. Fold the cardboard at each indicated fold line.

Step 4. At each fold, use scissors to cut two 2.54 cm (1 in) cuts at the indicated positions.

Step 5. Use box cutters to cut any lines not placed over a fold line.

Step 6. Fold the cardboard into a square. Slide two opposing slots together to form a lock.

Step 7. Push each pen holder tab inward toward the middle of the box using a finger.

Step 8. Push a pen through each of the 4 pen holder tabs.

Step 1. Cut a square of plastic wrap (peritoneum) approximately 15.25 cm × 15.25 cm (6 × 6 in). Cut small holes in each corner so pens impale the plastic wrap through each hole, holding it tightly in place.

Step 2. Cut a square of white felt (fascia) to approximately 15.25 cm × 15.25 cm (6 × 6 in). Adhere packing tape or masking tape in strips to cover entirety of cloth on both sides. Cut holes in each corner and impale on pens as with the peritoneum layer.

Step 3. Cut two rectangular pieces of red felt (muscle) to approximately 15.25 cm × 5 cm (6 × 2 in). Cut holes in each side for the felt to be impaled and held by protruding pens. Ensure holes are cut at correct locations so adequate tension is applied.

Step 4. Cut a square of sponge material (adipose tissue) to 15.25 cm × 15.25 cm (6 × 6 in). Cut 4 holes for pens to hold in place.

Step 5. Cut another square of white felt (skin) to the same size. Cut an additional hole in the middle for the balloon (umbilicus) to stick through. The balloon has been cut to include just the neck, oriented away from center. Do not add tape to this layer.

Step 6. Inflate a modeling balloon to simulate the bowel. Tape the balloon to the bottom of the plastic wrap (peritoneum layer). Apply a small amount of red lipstick on both sides of the modeling balloon.

Step 1. Rotate the laparoscopic box trainer on its side and orient the trocar module as shown.

Step 2. Mark two lines that line up with the top window of the trainer box using a pen. Use scissors to make 7.6 cm (3 in) cuts at both marked locations.

Step 3. Fold the cardboard flap over and slide it over the trainer box window. The trocar module should be securely attached to the trainer box and lie flat on the table surface.

Step 4. Cut two slits into the cardboard to provide a way to securely attach a cell phone to the top of the box (camera pointed down at trocar module). Slits should be wide enough to hold a rubber band between them. Slit length only needs to be approximately 1.3 cm (½ in).

Step 5. Attach the cell phone to the top using the rubber band, with camera directly above the trocar module. Place the phone directly above the module for direct visualization. Weights (such as textbooks) can be added inside the trainer box for stabilization.

• Trocar Placement Trainer — Introduction and Overview (Vimeo)
• Trocar Placement Trainer — Demonstration (YouTube)
• Trocar Placement Trainer — Training Session (Vimeo)

Source: ALL-SAFE/Trocar Placement/Simulation (ALL-SAFE Consortium).