Surgical Anatomy of Vaginal Hysterectomy—Impact of a Resident-Constructed Simulation Model

Anand, Mallika; Duffy, Conor; Vragovic, Olivera; Abbasi, Wafaa; Bell, Shannon

doi:10.1097/spv.0000000000000545

Cited by 9 publications

(12 citation statements)

References 12 publications

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“…The time to complete hysterectomy was greater than similar published studies [11], which is likely owing to the increased difficulty of dissection of the Flowerpot Model comparatively. Our overall trainee comfort with TVH value of 71.4% is similar to published values [16]. In addition, improvement in comfort after the education simulation session is also similar to the literature that reports a range of 80% to 100% [6,16].…”

Section: Discussionsupporting

confidence: 88%

“…Our overall trainee comfort with TVH value of 71.4% is similar to published values [16]. In addition, improvement in comfort after the education simulation session is also similar to the literature that reports a range of 80% to 100% [6,16]. After the simulation and education video, all participants reported satisfaction with performing TVH with attending supervisors and independently.…”

Section: Discussionsupporting

confidence: 86%

“…Barrier et al [18] previously described using a balloon and plastic wrap for bladder and peritoneal fold. The "No-excuses" model published uses very low-cost and readily available supplies within a hospital setting to describe the creation of a vesicovaginal septum with paper, gauze, glove, and plastic bags for simulation of anterior colpotomy [12,16]. These models lack realism and difficulty owing to the absence of a strong adhesive.…”

Section: Discussionmentioning

confidence: 99%

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Validation of Transvaginal Hysterectomy Surgical Model – Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation

Burkett

Makin

Ackenbom

et al. 2021

Journal of Minimally Invasive Gynecology

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To establish face and construct validity for a novel variation of American College of Obstetrics and Gynecology "Flowerpot Model" for transvaginal hysterectomy (TVH) surgical simulation with improved vesicovaginal dissection during surgical education simulation. Design: Cross-sectional face and construct validation study using the "Flowerpot Model." The vesicovaginal dissection plane was modified to include additional felt and balloon materials to simulate the bladder. Setting: Single academic center. Participants: Fourteen residents and fellows, postgraduate year (PGY) 2 to 6, subdivided into junior (n = 8) with ≤10 prior TVH surgeries and senior groups (n = 6) with >10 prior TVH surgeries performed. Interventions: All subjects watched a brief introductory video and then were filmed simulating a TVH. Measurements and Main Results: For face validity, subjects completed an anatomic checklist and pre/post simulation satisfaction survey. For construct validation, 2 independent, blinded expert surgeons (M.A. and J.M.) graded films using the Global Rating Scale of Operative Performance (GRS). Primary outcome was mean GRS between groups. The junior group consisted of PGY 2 to 3 with ≤ 10 prior TVH, median 7.5 (interquartile range [IQR] 6.75) and senior group PGY 3 to 6 with >10 TVH, median 19 (IQR 10) (p <.01). Subjects were "satisfied" or "very satisfied" with bladder and anterior peritoneal fold simulation (92%) and found vesicovaginal dissection "realistic" (100%). GRS score was significantly different between groups (juniors, 19.5 [IQR 5] vs seniors, 28.5 [IQR 8.5]; p = .048). Intergrader correlation was high (r = 0.87, p <.01). Surgeon volume of prior TVH was not significantly correlated to average GRS score, r = 0.49 (p = .10). The model improved comfort and confidence scores in the junior group more than senior group (p = .04), but senior group still had higher post simulation confidence scores than the junior group (p = .02). Conclusion: Face and construct validity with the modified Flowerpot Model was demonstrated. This low fidelity model is capable of simulation of a TVH with a novel vesicovaginal dissection. Prior surgical experience was not correlated to GRS score or time to procedure completion.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Validation of Transvaginal Hysterectomy Surgical Model – Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation

Burkett

Makin

Ackenbom

et al. 2021

Journal of Minimally Invasive Gynecology

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“…TVH = transvaginal hysterectomy. improve resident comfort and skills [6,9,11,12,19,20]. These models have ranged widely in anatomic fidelity, cost, and ease of assembly, but each has limitations.…”

Section: Figmentioning

confidence: 99%

“…For example, the simulation setup for the Greer et al [6] model as well as the Malacarne et al [8] model required the incorporation of a proprietary pelvic model used for shoulder dystocia, resulting in a significantly increased cost of reproduction. In studies such as the simulation by Anand et al [19], avoiding the use of a pelvic model resulted in limitations in anatomic semblance to realistic surgical cases as well as restriction in resident motor skill assessment. Accordingly, the evolution of this study's model was the result of iterative designs with construction and discussion among the 9 gynecologic surgeons on the research team regarding what would be most realistic and high yield in teaching vaginal hysterectomy as well as ease of construction and reproducibility among the sites.…”

Section: Figmentioning

confidence: 99%

Multi-institutional Validation of a Vaginal Hysterectomy Simulation Model for Resident Training

Zoorob

Frenn

Moffitt

et al. 2021

Journal of Minimally Invasive Gynecology

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The purpose of the research was to both develop a vaginal hysterectomy model with surgically pertinent anatomic landmarks and assess its validity for simulation training. Design: A low-cost, reproducible vaginal hysterectomy model with relevant anatomic landmarks for key surgical steps. Setting: Nine academic and community-based obstetrics and gynecology residency programs. Participants: One hundred sixty-nine obstetrics and gynecology residents. Interventions: A vaginal hysterectomy model with surgically pertinent anatomic landmarks was developed and tested for construct validity. Measurements and Main Results: Of the 184 available residents, 169 (91%) participated in this study and performed a vaginal hysterectomy procedure on the described model. The validated objective 7-item global rating scale (GRS) and the 13-item task-specific checklist (TSC) were used as tools to assess performance. The median TSC and GRS scores correlated with year of training, prior experience, and trainee confidence. In addition, the TSC scores also correlated with the GRS scores (p <.001) with regard to performance and resident year of training. Receiver Operator Curves for identification of the residents meeting national residency accreditation minimum numbers for vaginal hysterectomy using the GRS and TSC scores had an area under the curve of 0.89 and 0.83, respectively. Conclusion: This reduced-cost vaginal hysterectomy model offers high construct validity and pertinence for simulation.

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Pelvic + Anatomy: A new interactive pelvic anatomy model. Prospective randomized control trial with first‐year midwife residents

Pereda-Núñez

Manresa

Webb

et al. 2023

Anatomical Sciences Ed

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Detailed knowledge of female pelvic floor anatomy is essential for midwifery and other professionals in obstetrics. Physical models have shown great potential for teaching anatomy and enhancing surgical skills. In this article, we introduce an innovative physical anatomy model called “Pelvic+” to teach anatomical relationships in the female pelvis. The Pelvic+ model's value was compared to a traditional lecture in 61 first‐year midwifery students randomly allocated to either the Pelvic+ (n = 30) or a control group (n = 32). The primary outcome measure was a quiz comprised of 15 multiple choice questions on pelvic anatomy. Participants were assessed at baseline (Pre‐Test), upon completion of the intervention (Post‐Test1) and 4 months afterward (Post‐Test2). Satisfaction with the approach was assessed at Post‐Test1. Increase in knowledge was greater and the approach more accepted among resident midwives when Pelvic+ was used instead of standard lectures. Four months after the intervention, the improvement in knowledge was preserved in the Pelvic+ group. This randomized study demonstrates that the Pelvic+ simulator is more effective than classical learning for pelvic anatomy education, and offers a higher level of satisfaction among students during the educational process. Medical students training in obstetrics and gynecology, or any professional who specializes in the female pelvic floor might also benefit from incorporation of the Pelvic+ model into their training program.

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Surgical Anatomy of Vaginal Hysterectomy—Impact of a Resident-Constructed Simulation Model

Abstract: Residents desire additional model-based simulation training in VH, and such structured, model-based simulations can identify and address gaps in resident knowledge of surgical anatomy of this important operation.

Cited by 9 publications

References 12 publications

Validation of Transvaginal Hysterectomy Surgical Model – Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation

Validation of Transvaginal Hysterectomy Surgical Model – Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation

Multi-institutional Validation of a Vaginal Hysterectomy Simulation Model for Resident Training

Pelvic + Anatomy: A new interactive pelvic anatomy model. Prospective randomized control trial with first‐year midwife residents

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