Teaching Cystotomy Repair: Low Fidelity Model Provides Effective Simulation at Minimal Cost

Abstract

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.

Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

“…Alternatively, a cadaver pelvis could be purchased at a lower price (approximately $1769.00) as only the pelvis was utilized for this curriculum. The simulation toolkit was easily accessible and affordable, at approximately $1.50 per model [21]. Cost sharing between the Departments of Surgery and Obstetrics and Gynecology at our institution decreased the financial burden of the cadaver lab.…”

“…One urogynecologist performed all surgical skills assessments at baseline and six weeks post-curriculum. A low-fidelity bladder model adopted from the American College of Obstetricians and Gynecologists Simulation Working Group (Figure 1) was utilized during each assessment [21]. Two validated ob- in six domains: respect for tissue, time and motion, instrument handling, knowledge of instruments, flow of operation, and knowledge of specific procedure [22].…”

“…One cadaver was used for cystotomy repair training for $1114.50, or approximately $111.45 per resident (ten residents completed the cadaver curriculum). The American College of Obstetricians and Gynecologists' cystotomy simulator was approximately $1.50 per model [21]. Each model was used twice with each resident, once for the pre-test and once for the post-test.…”