INTRODUCTION: Posterior colporrhaphy is an important surgical skill for gynecologic surgeons to treat symptomatic pelvic organ prolapse. The Accreditation Council for Graduate Medical Education (ACGME) includes pelvic floor procedures such as posterior colporrhaphy as a requirement for OB/Gyn trainees, further establishing this surgery to be integral for learners. Surgical trends show decreased vaginal hysterectomies nationwide; therefore, simulation of vaginal surgery is more important than ever. Simulation models allow procedures such as posterior colporrhaphy to be learned and practiced by trainees who lack exposure in their teaching institution as well as for surgeons looking to maintain their skills. Current posterior colporrhaphy models include animal tissue such as beef tongue. Limitations to existing models involve cost, re-usability, anatomic variability, and may impose ethical or personal conflicts for certain learners. Additionally, current published models do not include a rectal simulation, which is a key step of all posterior colporrhaphy surgery to ensure rectal integrity in live surgery. OBJECTIVE: To create a low-cost, easily reproducible posterior colporrhaphy simulation model designed for training gynecologic surgeons. METHODS: A low-fidelity model was created for simulation of a posterior colporrhaphy using craft materials easily available to purchase and construct. RESULTS: The model created includes a simulated rectum by using layers of spandex to replicate rectal mucosa, white chiffon with a red pattern to replicate adventitia with plexus of blood vessels, and white chiffon to replicate the vaginal fibromuscularis layer. Pink fuzzy socks were used to replicate the levator muscles, and a chamois cloth serves as vaginal epithelium. The base vaginal surgery model has been previously published and is required for this simulation. The rectum is positioned posterior to repair to allow learners to perform a digital rectal exam following the plication of the fibromuscularis. The initial cost to build the model is 45; however, the cost per use is 4. 50 as the materials used can be used to create over ten models. The rectum portion of the model is reusable. The integral piece that must be re-constructed each time is the chamois cloth that simulates the vaginal epithelium. This model allows for learners to understand the important steps of the posterior colporrhaphy, including the dissection of the vaginal epithelium from the underlying fibromuscularis, plicating the fibromuscularis layer, and performing a rectal exam to ensure no stitches have penetrated the rectum and need to be removed. This model was incorporated as a part of a resident vaginal surgery simulation curriculum and has received positive reviews. CONCLUSIONS: This low-fidelity, low-cost, easily reproducible posterior colporrhaphy simulation model is easy to create and has positive reviews. It has been instrumental in teaching future vaginal surgeons the steps and techniques to perform posterior colporrhaphy. With the addition of a simulated rectal exam component, tissue layers, and levator muscles, this model bridges a gap in previously published models to enhance the educational experience and support trainees’ vaginal surgery skills despite declining operative exposure.
Vallabhaneni et al. (Fri,) studied this question.