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A Cost-Effective, Reproducible and Novel Vaginal Hysterectomy Model
IUGA Academy. Iyer S. Jun 30, 2018; 213279
Shilpa Iyer
Shilpa Iyer

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151

A Cost-Effective, Reproducible and Novel Vaginal Hysterectomy Model

Alsaden, I1; Rugino, A1; Senapati, S2;Iyer, S3; Botros, C3

1: University of Chicago Medicine; 2: NorthShore University HealthSystem; 3: University of Chicago/NorthShore University HealthSystem

Introduction: Vaginal hysterectomy (VH) has been associated with better outcomes and fewer complications compared to other routes of hysterectomy. The vaginal route is the preferred choice for benign hysterectomy, as recommended by the American College of Obstetrics and Gynecology1. However, as laparoscopic hysterectomy has become more common, numbers of VHs have decreased, with half of obstetrics and gynecology residency graduates completing 18 or fewer VHs as the primary surgeon. Studies have demonstrated that residents require 21 VHs to become competent2. Surgical models and use of simulation can improve residents’ comfort level with VH, but realistic and cost-effective models for VH are lacking1.

Objective: We aim to create a novel, cost-effective and reproducible VH model, which will be utilized in a surgical skills curriculum for obstetrics and gynecology residents.

Methods: To assess the need for an adjunct to resident surgical training for VHs, a questionnaire was sent to residents at an academic medical center, which evaluated their comfort level with performing a VH. After reviewing the results of the survey, a VH model was created using materials found at craft or hardware stores. A 4” to 6” rubber plumbing joint was mounted to a board and used as a reusable pelvis. Holes were drilled in appropriate locations in order to attach a uterus and bladder (balloon filled with water) within the pelvis (figure 1). The rectum was a two-layer tubular structure made from cotton quilt batting for serosa and wefting for mucosa. A uterus was hand sculpted from clay and then cast into a reusable silicone rubber mold. Pourable foam was placed in the mold to create copies of uteri that were attached to the pelvis using a series of rubber bands as ligaments. Press and seal was used to simulate peritoneum. The focus of the model was to simulate the essential elements of a VH: demonstrate the underlying pelvic anatomy, proper placement of clamps, and tying secure square knots vaginally (figure 2). A video was created to show the steps of model creation and use of the model to perform a VH.

Results: Only 20% of residents felt “comfortable” performing a VH, while 65% felt either “uncomfortable” or “very uncomfortable”. The cost of 60 models was approximately $500. The initial investment for reusable materials and silicone rubber mold materials was $300. The cost per foam uterus and other disposable materials was between $2.50-$3.00.

Conclusion: This vaginal hysterectomy model provides a realistic model and will improve resident comfort level with VHs in a cost-effective manner. With increasing opportunities to practice VHs in a safe and controlled simulated environment, residents may graduate feeling more comfortable independently performing the VH.

References

  1. Committee on Gynecologic Practice. Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;Jun;129(6):e155-e159.
  2. Washburn EE, et al. Trends in reported resident surgical experience in hysterectomy. J Minim Invasive Gynecol. 2014;21(6):1067-70.

Disclosure:

Work supported by industry: no.

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