13: Validation of an educational simulation model for vaginal hysterectomy (VH) training design: Prospective cohort study

Abstract

OBJECTIVES: There is currently scant evidence regarding bladder symptoms in irradiated pelvic cancer survivors; therefore, we sought to estimate the prevalence of urogynecologic diagnoses in women previously irradiated for pelvic cancer. MATERIALS AND METHODS: Using ICD-9 diagnosis and procedure codes, we created a de-identified dataset via the University of California Cohort Discovery Tool containing all patients diagnosed with a pelvic cancer (ovary, uterine, endometrial, cervical, rectal/anal) and treated with radiation between 1992 and 2015 at University of California, Irvine (UCI) and University of California, Los Angeles (UCLA). All cases were further analyzed to determine prevalence of varying urogynecologic diagnoses. Similar variables were also measured in women with fibroids. RESULTS: A total of 7,100 and 8,078 women at UCI and UCLA were diagnosed with a pelvic cancer between 1992 and 2015. Of these, 11.87% and 6.71%, respectively, were treated with radiation. A total of 5,842 and 20,505 women were diagnosed with fibroids. Prevalence of any urogynecologic diagnosis in the cancer and fibroid group was 23.32-28.29%, however, those exposed to radiation were diagnosed more than 50% of the time. On further stratification, odds of cystitis and hematuria were similar in the cancer and fibroid groups; yet, with radiation, the odds of diagnosis significantly increased by 2.9 to 4.7-fold. Prevalence of urinary incontinence was also significantly increased in women treated with radiation by 2.23 to 2.86-fold. Finally, relative to women with fibroids, those with cancer had an increased prevalence of hydronephrosis and urinary obstruction, which was further accentuated with radiation by 4.74 to 5.29-fold. CONCLUSION: Radiation significantly increases the prevalence of almost every urogynecologic diagnosis relative to cancer and noncancer controls. OBJECTIVES:The Miya Model is a female pelvic anatomy model designed for realistic gynecologic surgical simulation. The model has life-like features to simulate actual surgical experiences including vaginal epithelium, pelvic viscera, realistic cutting and puncturing tensions, palpable surgical landmarks, a pressurized vascular system that bleeds, and an inflatable bladder that will leak if damaged. We hypothesized that for the performance of VH, the model would discriminate between novice and experienced surgeons using operative times, blood loss and overall surgical skills as judged on video review using the ACOG VH Assessment Tool (ACOG Simulation Consortium, ASSESS Course Instructor Manual). MATERIALS AND METHODS: Twenty physicians, 10 Ob/Gyn residents (novice group) and 10 practicing gynecologists (experienced group, mean number of years in practice ¼ 14.3 years) were recruited to participate in the study. All surgeons were instructed to perform a VH on the model according to the procedural steps outlined by the Society of Gynecologic Surgeons and ACOG. Each participant was given a maximum of 60 min and was filmed during the simulated surgery. Either the time taken to ...