INTRODUCTION: Vaginal and transabdominal uterine morcellation using various techniques may be required in complex pelvic surgery depending on patient anatomy and surgical route. Morcellation is known to be safer when performed by an experienced surgical team, and therefore advanced gynecology trainees should be well versed in morcellation techniques. Simulation-based learning is an ideal way to supplement training in a safe environment. OBJECTIVE: We present a low-cost, reproducible simulation model designed for training in practicing abdominal and vaginal uterine morcellation. METHODS: Several materials were tested to create a reproducible uterus, with pourable silicone ultimately selected for its close match to the tactile feel of uterine tissue. A 3D-printable mold was developed in which the pourable silicone may be set to the desired shape. Total cost of required materials is 63. 79 (Figure 1). To create an abdominal morcellation model, an approximately 2-inch opening, simulating a laparoscopic port site, is cut in the center of a storage container. The opening is wrapped in foam insulation tape to seal off any sharp edges. Craft foam and vinyl are then cut to size to completely cover the bottom of the storage container, and an approximately 2-inch opening is then cut into the center of the combined materials to match the opening of the container. These materials are affixed together and then attached to the storage container. Total cost of these materials is 67. 92. A vaginal morcellation model was created similarly to previously published vaginal surgery models, and a 3-inch diameter curved PVC pipe connector was affixed to the model, with material costs totaling 23. 04. The model setup can be used multiple times. Additional materials needed include a scalpel, tenacula, a plastic sandwich bag, and Kocher/Kelley clamps. RESULTS: To practice abdominal morcellation, the uterus specimen is placed inside the plastic bag, and fed through the simulated port opening. The abdomen model is then secured to a flat surface. The ends of the bag may then be clamped with Kelley clamps. Kochers are applied to the uterus, and the uterus is then morcellated using successive c-shaped incisions with the scalpel while applying traction with the Kochers. Following removal of the specimen, the bag may be inspected for any areas of unintended perforation. To practice vaginal morcellation, the vaginal model is affixed to a flat surface. The uterus is directed through the PVC pipe, positioned with the cervix facing the surgeon, and the cervix is grasped with tenacula (Figure 2). The uterus can then be morcellated via several methods: wedge morcellation, intramyometrial coring, and bivalving/hemisection. Models may be created based on the desired level of difficulty, varying the uterine size or shape, or including a rubber ball to simulate a myoma. CONCLUSIONS: This is a novel, inexpensive, easily constructed model that accurately simulates uterine morcellation and can be reused multiple times. It is easily modified to simulate different anatomic challenges. Uterine morcellation is an important skill in gynecologic surgery, and this model will allow learners to work towards mastering this skill in preparation for live surgery. Figure 1Figure 2
Wood et al. (Fri,) studied this question.