A Novel and Inexpensive Vaginal Hysterectomy Simulator

Barrier, Breton F.; Thompson, Amy B.; McCullough, Michael; Occhino, John A.

doi:10.1097/sih.0b013e318266d0c6

Cited by 31 publications

(15 citation statements)

References 4 publications

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“…Recent literature contains suggestions for improving education through simulation models (22), objectively evaluating vaginal surgical skills (23), and techniques to address a difficult hysterectomy (24). Another way to improve trainee experience is to increase vaginal hysterectomies.…”

Section: Discussionmentioning

confidence: 99%

Determining Optimal Route of Hysterectomy for Benign Indications

Schmitt¹,

Leon²,

Occhino³

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy. Methods A retrospective post-robot cohort of benign hysterectomies (2009-2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded laparoscopic hysterectomy route. A pre-robot cohort (2004-2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated. Results Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the pre-robot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy, with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the post-robot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%), robot-assisted; and 136 (11.4%), abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when vaginal approach was expected. Robotic hysterectomies had longer operations (141 vs 59 minutes, P<.001) and higher rates of surgical site infection (4.7% vs 0.2%, P<.001) and urinary tract infection (8.1% vs 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years. Conclusion When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible.

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Section: Discussionmentioning

confidence: 99%

Determining Optimal Route of Hysterectomy for Benign Indications

Schmitt¹,

Leon²,

Occhino³

et al. 2017

Obstetrics &Amp; Gynecology

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“…Meanwhile, studies assessing the transferability of laparoscopic and endoscopic simulators to real-time performance have proved to be useful of simulatorbased training (14,15,18,19). A VH simulator has been shown to have beneficial effects in learning routine VH (20,21). Although Greer et al (21) have shown that structured multiplecomponent VH education is valid, the impact of VH simulation on surgical competence could be unproven.…”

Section: Discussionmentioning

confidence: 99%

The impact of a simulation-based training lab on outcomes of hysterectomy

Asoğlu¹,

Achjian²,

Akbilgiç³

et al. 2016

J Turkish German Gynecol Assoc

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Results:The average estimated blood loss before and after simulation-based training was significantly different in TAH and RAH groups (317±170 mL versus 257±146 mL, p=0.003 and 154±107 mL versus 102±88 mL, p=0.004, respectively), but no difference was found for TLH and VH. The mean of length of hospital stay was significantly different before and after simulation-based training for each technique: 3.7±2.3 versus 2.9±2.2 days for TAH, 2.0±1.2 versus 1.3±0.9 days for VH, 2.4±1.3 versus 1.9±2.5 days for TLH, and 2.0±1.3 versus 1.4±1.7 days for RAH (p<0.01). Conclusion:Based on our data, simulator-based training may play an integrative role in developing the residents' surgical skills and thus improving the surgical outcomes of hysterectomy. (J Turk Ger Gynecol Assoc 2016; 17: 60-4)

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“…Vaginal hysterectomy was taken to be more difficult for other indications because of severe pelvic adhesions frequently seen in Nigerian women requiring hysterectomy, low surgical experience and expertise, and reduced exposure of residents in surgical competence in virtually all the centres in Nigeria [27,28,29]. Complex anatomy of the pelvis and technical challenge contribute to a steep curve for inexperienced surgeons [30]. Most centres hardly do up to five vaginal hysterectomies in a year.…”

Section: Indicationsmentioning

confidence: 99%

Underexposure of Residents in Training in the Art of Vaginal Hysterectomy in Nigeria

Tc¹,

Ikeako²,

Ezenyeaku³

2014

AJCMR

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Worldwide, vaginal route is the gynaecologist's route of surgery. However, abdominal route is the favoured route of hysterectomy in Nigeria inspite of the advantages of vaginal route. This descriptive review is to awaken interest in the teaching and surgical exposure of residents in obstetrics and gynaecology in the field of vaginal surgeries. The ratio of vaginal hysterectomy to abdominal hysterectomy in Nigeria ranges from 1:4 to 1:9. The frequency of vaginal hysterectomy in centres in Nigeria ranges from 10-23%. These rates are lower than the figures quoted from the United States (25%), France (50%), Australia (40-50%) and Saudi Arabia (28%). Vaginal hysterectomy is under-utilized in Nigeria. Most centres hardly do up to five vaginal hysterectomies in a year. Residents in training hardly perform vaginal hysterectomy and may not have watched or assisted in up to ten vaginal hysterectomies before the residency programme is completed. This is completely inadequate for acquisition of proficiency. There is inadequacy and under exposure of residents in the art of vaginal surgeries in Nigeria. There is need for workshops, training and retraining of residents in the field of vaginal surgeries to meet these challenges. This would ensure production of quality gynaecologists with skills and proficiency in vaginal surgery.

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A Novel and Inexpensive Vaginal Hysterectomy Simulator

Abstract: This technical report details the construction of a vaginal hysterectomy simulator, the individual parts, the cost of each part, and the results of a blinded survey of resident physicians who used the simulator during their vaginal hysterectomy instruction.

Cited by 31 publications

References 4 publications

Determining Optimal Route of Hysterectomy for Benign Indications

Determining Optimal Route of Hysterectomy for Benign Indications

The impact of a simulation-based training lab on outcomes of hysterectomy

Underexposure of Residents in Training in the Art of Vaginal Hysterectomy in Nigeria

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