Development and Validation of a Low-fidelity Simulator to Suture a Laparotomy in Rabbits Juan J. Pérez-Rivero, Tonantzin Batalla-Vera and Emilio Rendón-Franco An easily constructed, low-cost simulator is assessed for its efficacy in the surgical training of veterinary science undergraduates DISCUSSION Introduction There is a growing need for the development of alter- natives to reduce, replace and refine the use of ani- mals for surgical training in contemporary veterinary education at the undergraduate level. In the present study, a simulator to suture a midline laparotomy in the rabbit was designed, that could be constructed from widely-available and low-cost materials. The simulator was used to develop surgical skills in stu- dents at the undergraduate level of veterinary med- icine. Thirty-five, third-year veterinary students, with no previous surgical experience, were divided into two groups: a control group that did not use the simulator (n = 19), and an experimental group that used the simulator three times to practise the sutur- ing of a laparotomy (n = 16). Later, both groups per- formed a midline laparotomy in an anaesthetised rabbit, and the rate of closure of each anatomical plane (peritoneum, additional reinforcement, and skin) was measured. The usefulness of simulators The surgical training of undergraduate students by using live animals provides few opportunities for real training and is applicable only to certain surgical techniques. In addition, it also raises serious ethical and animal welfare considerations. The students themselves are also subjected to a level of stress, this being, in most cases, a cause of errors. Con- sequently, they do not adequately benefit from the training provided. 1,2 In veterinary medicine and animal sciences, the Three Rs principles are being implemented as widely as possible. This involves the reduction, replacement and refinement of animal use, both in experiments and in teaching. 3 One way to accomplish this is through the use of various simulators in their differ- ent forms, such as synthetic simulators, multimedia simulations, virtual reality, carcasses, and ethically- sourced animal tissues. 4,5 These provide training alternatives, which permit the acquisition of skills to successfully meet the needs of future clinical and surgical experiences with live patients, and to ensure that maximum educational value is achieved during practical training. 6 The fidelity of a simulator is determined by how much realism is provided through characteristics such as visual cues, touch, the ability to feedback, and interaction with the student. In general, simulators can be divided into two groups: high-fidelity simula- tors, which are usually highly technical, detailed and realistic; and low-fidelity simulators, which have a low level of realism, are usually made with widely- available and low-cost materials, are often portable, and can be used on a table. Despite their simplicity, the latter group of simulators assist the development of psychomotor skills. 7 Some limitations of the use of simulators are related to their cost or difficulty in sourcing spare parts. Moreover, despite the large number of simulators that have been developed, few studies have been conducted to evaluate their effec- tiveness, leaving the concept of teaching through simulators at an empirical stage. 8 Therefore, it is necessary to develop inexpensive, easy-to-construct simulators that support the process of surgical teach- ing, and also to quantitatively assess the effective- ness of their use. Therefore, the aim of this work was to develop and validate a low-fidelity simulator to assist in the teaching of the correct technique for closing a rabbit midline laparotomy. Development of the simulator A 10cm long and 4cm wide opening was made in an empty plastic 500ml solution bottle (Pisa Agro- P44 ATLA 43, P44–P48, 2015