Development of a low-cost laparotomy and fascial closure simulator

Introduction The ability to gain access to the peritoneal cavity and perform dependable fascial and skin closure is foundational in surgical training. We developed and evaluated a realistic, low-cost synthetic abdominal wall simulator incorporating a biomechanically similar fascial layer. Methods We iteratively engineered a layered abdominal wall model in an 18 × 18 cm frame using pigmented silicone elastomers and a nylon/spandex power mesh to emulate fascia, muscle, adipose tissue and skin. Ten practising surgeons at a US academic military hospital performed a midline laparotomy and closure on the device and then rated realism (palpation, incision, grasping, suturing, stapling) and the model’s acceptability for training. Cost and build time (including cure intervals) were recorded. Results Tooling cost for the reusable mould and rectus frame was approximately 125, with 34. 38 in materials per additional unit. Using two frames, manufacture time was ~21 hours, driven by cure times across layers. After use, nine out of ten surgeons rated palpation, incision and suturing as somewhat similar or similar to living tissue; six out of ten rated grasping as somewhat similar or similar; eight out of ten rated skin stapling as somewhat similar or similar; ten out of ten judged the simulator acceptable for teaching midline laparotomy; and nine out of ten judged it acceptable for teaching fascial closure. Discussion Our construct provides a reproducible, inexpensive simulator for teaching laparotomy creation and closure using widely available materials. Surgeon ratings support acceptable face realism and broad training utility, with grasping fidelity identified as a target for refinement. Future work should incorporate trainee perspectives, multi-institutional testing and iterative material adjustments to optimize handling characteristics.