Teaching Vaginal Hysterectomy: Low Fidelity Trainer Provides Effective Simulation at Low Cost

Abstract

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.

How to teach vaginal surgery through simulation

“…Many models created and described in the literature are variations of the models mentioned above, and many use commercially available low-cost bony pelvis models and polyvinyl chloride (PVC) pipes as a foundation for the soft tissue inserts to attach. 12,13,[31][32][33] Each model varies on what it "teaches best" regarding realismfor example, teaching anatomy, working in a tight space, dissection, or clamp placement and suture ligature. Furthermore, since vaginal hysterectomy is a high-complexity procedure in terms of skills (working in confined space, limited view, "upsidedown" anatomy, and need to direct assistants for retraction and exposure), task breakdown is important for simulation learning, as it is not efficient to repeat the entire procedure until proficiency is reached.…”

Society of Gynecologic Surgeons meeting champions training of future gynecologic surgeons

“…Many models created and described in the literature are variations of the models mentioned above, and many use commercially available low-cost bony pelvis models and polyvinyl chloride (PVC) pipes as a foundation for the soft tissue inserts to attach. 12,13,[31][32][33] Each model varies on what it "teaches best" regarding realismfor example, teaching anatomy, working in a tight space, dissection, or clamp placement and suture ligature. Furthermore, since vaginal hysterectomy is a high-complexity procedure in terms of skills (working in confined space, limited view, "upsidedown" anatomy, and need to direct assistants for retraction and exposure), task breakdown is important for simulation learning, as it is not efficient to repeat the entire procedure until proficiency is reached.…”