Fowl Play Can Lead to Improved Surgical Skills: A Novel Simulation Model for Bladder Flap Creation, Colpotomy, and Vaginal Cuff Closure

Abstract

Study Objective

The objective was to create a reproducible simulation model designed for trainees that incorporates 3 important laparoscopic hysterectomy surgical skills: the creation of the bladder flap, the creation of the colpotomy, and vaginal cuff closure.

Design

This simulation model utilizes a chicken drumstick with skin to represent the lower segment of the uterus and cervix. The model has 3 parts. The first part simulates the creation of the bladder flap. The drumstick is mounted to a uterine manipulator by inserting the manipulator through the joint of the drumstick and advancing the colpotomy cup over the joint. The skin of the drumstick serves to function as the bladder peritoneum and the goal is to laparoscopically incise the skin and bluntly dissect the skin down towards the joint. From there, after ensuring the skin is circumferentially dissected, the skin is then everted and folded down over the joint of the drumstick and over the colpotomy cup. The skin is secured down with a purse string suture. This is to facilitate the second part of the simulation, the creation of the colpotomy. For the third part, the vaginal cuff closure, the drumstick is removed from the manipulator and the joint of the chicken leg is then positioned towards the endoscope. The circumferential skin incision will mimic the vaginal cuff.

Setting

This model should be performed in a simulation lab that is capable of accommodating raw animal products.

Patients or Participants

No patients or participants are included.

Interventions

No treatment or intervention was employed.

Measurements and Main Results

There is no data to share.

Conclusion

We successfully created a simulation model that can be utilized by trainees to practice three key skills employed in a laparoscopic hysterectomy. This model successfully allows for the practice of bladder flap creation, colpotomy creation, and vaginal cuff closure. This simulation model is cost-effective and easily reproducible.