A cystocele is the most common type of pelvic organ prolapse. Native tissue anterior colporaphy is the traditional surgical repair for cystocele. The ACGME requires a minimum of 25 incontinence and pelvic floor surgeries for graduation from OB-GYN residency. Furthermore, the most recent educational objectives of the CREOG listed anterior repairs as core procedure, which means that residents graduating from OB-GYN residency are required to understand and independently perform this procedure upon graduation from residency. Simulation is particularly beneficial when consistent surgical volume may be lacking to become proficient. Simulation-based learning provides a low-stress, risk-free environment and the opportunity to develop and perfect surgical skills prior to applying them in the operating room. The purpose of this video presentation is to present a design for surgical simulation training model for anterior colporaphy. This simulation model may serve as a valuable learning tool for OB-GYN trainees. The simulator construction is affordable and easily reproducible. Components of our model are the following, a pair of tights, 4-inch PVC pipe connector, 8x8 inch wooden base, 4.5x5 inches of half-inch batting sheet, four pieces of 4x2 inch Velcro, two thumb screws, perforated steel duct strap, and batting for stuffing. You will also need a spray adhesive and half-inch Velcro dots. The construction of this training model is affordable as the overall cost is less than $50. The tights and the batting sheet are the only materials that are non-reusable. We will now demonstrate the construction of the model step-by-step. The first step in model construction is to attach Velcro to the outside of the PVC pipe on both sides. Next, we construct the bladder by cutting the tights 6 inches in length from the toe. Stuff the toe with batting to model the bladder. Set the bladder aside for the time being. A piece of tights cut to 11 inches will be used to construct the vagina. One end of the tights is pulled up over the rim of the pipe at the end where the cystocele will be created and attached to the Velcro. The batting is used to simulate the vesicle vaginal adventitia. Spray adhesive is applied onto the 4.5 by 5 inch sheet of batting. This sheet is then placed against the inside of the tights to overlay the cystocele. The bladder is then affixed inside the pipe with a Velcro dot so that the bladder is protruding outside of the pipe to replicate the prolapse. The other end of the tights is stretched over the other rim of the pipe and attached to the Velcro. The model is then attached to the wooden board by placing the strap over the top and screwing the strap in place with thumb screws. The PVC pipe can be rotated along the strap to simulate posterior coporaphy if desired. Our model allows trainees to practice and perfect all aspects of the procedure. A transverse incision along the anterior vaginal wall is made. The edges are grasped with Alice clamps. The batting which simulates the vaginal muscularis is dissected from the underlying vesicle vaginal adventitia as simulated by the batting sheet. The use of batting simulates the avascular space and allows for a life-like dissection as demonstrated here. Placation stitches using tool PDS are placed along the length of the defect. Trainees may choose to practice transverse placation or box placation. The excess vaginal epithelium is trimmed and the vaginal epithelium is closed using 2-O-Vicrol in a running locking manner. In conclusion, the surgical model presented in this educational video is inexpensive, easily reproducible, and portable. It is designed to aid in learning this common gynecologic procedure. This model may also aid in learning how to use surgical assistance in vaginal surgery. Once the model is validated, it may also be used as an assessment tool.

surgical simulation training model

anterior colporaphy

OB-GYN trainees

model construction

portable model