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PURPOSE: To develop an inexpensive bladder model that can be used to teach Ob-Gyn Residents open and laparoscopic cystotomy repair. BACKGROUND: Recognition of cystotomy and repair is a requirement of Ob-Gyn surgical milestones. Simulation products currently exist for cystoscopy but not for cystotomy repair. METHODS: Pilot study of a novel low fidelity bladder model that can be used for simulation of both open and laparoscopic cystotomy repair. A cystotomy model was created using the following materials: small whoopee cushion “bladder mucosa”, shelf liner “bladder muscularis” and Press'n Seal® for “serosa.” Markings were placed inside the cushion to represent the trigone with ureteral orifices. Residents were asked to identify the model’s anatomic landmarks and rate their confidence in identifying cystotomy and performing both and open and laparoscopic cystotomy repair, pre- and post-simulation. RESULTS: 16 bladder models were constructed for approximately $1.50 per model. The model is reusable and manipulated well with surgical instruments and suture both open and laparoscopically; the model was a bit large for the laparoscopic trainer and lighting became a challenge for suturing. All participating residents correctly identified the anatomic structures post-simulation compared to 12/13 pre-simulation. Change in mean resident confidence was statistically significant for identifying cystotomy (pre M=3.1/5 vs. post M=4.2/5, P=.009) and performing open cystotomy repair (pre M=2.4/5 vs. post M=4/5, P=.03) but not for laparoscopic repair (pre M=1.6/5 vs. post M 3.1/5, P=.09). DISCUSSION: Our bladder model is easily constructed and inexpensive. It performs well for open cystotomy repair but has been decreased in size to better perform laparoscopically.

BACKGROUND: Decline in hysterectomies and provider comfort have led to decreased exposure to total vaginal hysterectomy (TVH) during residency training. Commercial simulation products exist but are cost-prohibitive for consistent use in training. METHODS: Pilot study of a novel low fidelity TVH trainer. A complete vaginal hysterectomy trainer was modified from previously published models to include vulva (for operating in confined space) and more realistic-feeling materials. Items used included: “pelvic base”- flower pot and board; “vulva”- pink foam cowboy hat; uterine insert (suspended within pelvic base) composed of “uterus”- pool noodle, “uterosacral ligaments”- elastic bands, “round ligament and fallopian tubes”-long balloons, “ovaries”- round balloons, “vessels and ureters”-pipe cleaners, and “peritoneum”- Press'n Seal. Residents rated confidence in performing TVH, pre- and postsimulation with trainer. RESULTS: Five reusable pelvic bases ($10/base) and 16 replaceable uterine inserts ($2/insert) were constructed. The trainer functioned well with surgical instruments and suture, although reloading the pelvic base was time consuming. All participating residents (n=14) successfully performed the steps of TVH. Change in mean resident confidence was statistically significant pre- (M=2.08/5) and post- (M=3.17/5) simulation, P=.004. DISCUSSION: Our trainer is easily constructed for minimal cost. It can be used in residency training programs to simulate total vaginal hysterectomy and improve resident confidence in performing TVH. We have since updated the base to a flip-top trashcan to facilitate reloading.

PURPOSE: To develop a model that can be used by Ob-Gyn residents when performing simulation for laparoscopic myomectomy. BACKGROUND: Laparoscopic myomectomy (LM) is a challenging procedure encountered by Ob-Gyn residents during residency training. Limited commercial simulation products exist but are cost-prohibitive for consistent use. METHODS: Uterine and fibroid molds were generated using Pixelogic® Z-brush design software and printed from a 3D printer using polylactic acid filament. Smooth-On® Dragon Skin silicone of varying densities was used for the uterus and fibroids. The model consisted of a uterine body with four fundal subserosal fibroids – two placed anteriorly and two placed posteriorly—fallopian tubes, and round ligaments. Residents evaluated the model and its effectiveness in simulating LM upon simulation completion. RESULTS: Five uterine models with four fibroids each were constructed for a total cost of $318 (printed molds, silicone, and pigment); replacement models cost $30 (silicone and pigment only). The model functioned well within the trainer box using surgical instruments and suture; however, the base of the fibroid adhered to the myometrium making excision of the entire specimen difficult. All residents (N=13) used the model. Residents felt the model was realistic (4/5), helps develop skills needed for LM (4.5/5), and will increase resident competency in laparoscopy (4.8/5). DISCUSSION: Our model provides a realistic simulation of LM at low cost. One model can be used by up to four residents. We can repair previously used models with silicone allowing them to be reused. We have updated the model to decrease fibroid adherence to the myometrium and facilitate complete excision.

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