In this video, we'd like to explain how to construct our vaginal hysterectomy simulation model. First, create the pelvic viscera consisting of the uterus, the bladder, and the rectum. To do this, we're going to use white modeling material, which is soft and pliable initially and dries to a more solid texture in 72 hours. Weigh 64 grams of the model magic for the uterus, 44 for the rectum, and 24 for the bladder. Next, we'll zip tie our resin pelvis strategically around certain points in order to attach our ligaments. We'll use a can of zip ties, which includes 11-inch and 7-inch zip ties. Place one tie across the pubic symphysis, another through the obturator foramen immediately, around the midpoints of the two superior pubic rami. Place zip ties bilaterally across the acetabulum and through the obturator foramen around the ischium. Loop a final zip tie through the S3 sacral foramena, which will later loosely secure the rectum. Next, wrap the organs using two knee highs. Wrap the uterus, knot it at one end, and invert the end of the hose to later use for the vagina. Use a rubber band to demarcate the cervicovaginal junction. Then, evert the vagina. Mark the uterus bilaterally at the utero sacral, cardinal, utero ovarian, and round ligaments and set aside. Use the second knee high to wrap the bladder and the rectum. Take the seam side of the nylon, grasp the dome of the bladder, and pull it taut. Tie off the urethral end. Cut off the redundant nylon, and use the remaining piece to wrap the rectum. Knot the knee high at both ends. Make two small cuts at the posterior dome of the bladder in which to thread the ureter. Using a tweezer and forceps, thread a quarter inch wide 45 centimeter length of yellow ribbon through the holes until it's even. Insert the bladder into the zip tie at the pubic symphysis. Gently press in to secure. Now, thread the ureter through the lateral two zip ties at the superior pubic ramus and the acetabulum, finally over the SI joint to the back. And here you can see the course of the ureter as it ultimately crosses the pelvic brim. Suture the posterior aspect of the ureters through the S1 foramen bilaterally to secure them. Ovicral suture is used here as demonstrated. Again, you can see the course of the ureters. Recall that we previously marked the points for our uterine attachments. Make slits in each of these locations on both sides of the uterus. The uterus sacral will be threaded through the posterior surface of the uterus. And then, the remaining attachments will be threaded anteriorly, namely the cardinal ligament, the uterovarian, and the sacral. Namely, the cardinal ligament, the uterovarian, and the round ligament in order to properly suspend the uterus within the pelvis. Now, take the uterus and place it into the pelvis and thread, but do not secure, the round ligaments through the zip ties across the midpoints of the superior pubic rami. This helps to hold the uterus temporarily while threading the remaining ligaments. Next, take the utero sacral ligament and thread it through the ischial and acetabular zip ties. Bring the end of the utero sacral ligament to the S2 foramen and stitch it with ovicryl to secure it, ensuring it's tight. Repeat on the contralateral side. Now, take the cardinal ligament and thread it through only the ischial zip tie and ensure it is taut before suturing it. Remember, the uterine artery runs through it. Cut the redundant portion. Thread the uterovarian ligaments through only the acetabular zip tie. Thread the uterovarian ligaments through only the acetabular zip ties securing with ovicryl. Retension the round ligaments to complete the uterine suspension and stitch them to the superior pubic rami zip ties with ovicryl. Thread the fallopian tubes at the uterine corneae at the same insertion point as the round ligament and the fallopian tubes just lie posteriorly. Next, take a piece of gauze and thread it through the zip tie at the posterior aspect of the bladder. Pull it through and spread it out. This creates the pubocervical fascia, a part of the endopelvic fascia, also known as the pubovesicocervical fascia or the vesicocervical or supravaginal septum. Cut the excess gauze and tape the free end on to the anterior surface of the cervix using scotch tape. Rotate the pelvis and thread the gauze through the endopelvic fascia. Rotate the pelvis and tuck a piece of fiberfill between the bladder and the uterus up to the level of the vesicocervical septum. This represents the areolar tissue of the vesicouterin or vesicocervical space. Rotate the pelvis again. Use the free end of the hose to create the tension on the cervical vaginal epithelium by wrapping the hose around the ischial tuberosities and pubic symphysis. Although this does not create a fully anatomic vaginal canal, it allows for easy access to the cervix for the simulation and nicely demonstrates the cervical vaginal epithelium. Rotate the pelvis again to apply the peritoneum. Take a clear plastic vegetable bag opened up. Loosely drape it across the pelvic inlet and tuck it in between the viscera to create the vesicouterin and rectouterin peritoneal folds. Be sure that your rectouterin peritoneal fold is more anatomically inferior compared to the vesicouterin peritoneal fold. Place the rectum into the sacral zip tie and then secure the plastic bag to the anterior surface of the rectum, the anterior and posterior uterus, and the posterior bladder using double-sided tape. Finally, secure the lateral aspects of the peritoneum to the ilium with double-sided tape. Cut the redundant peritoneum. Cut the redundant peritoneum. Advantages of this model are its representation of key anatomic structures, especially for anterior colpotomy. It's used to practice steps of vaginal hysterectomy, and it's low-cost. Thank you.

vaginal hysterectomy

simulation model

modeling material

pelvic viscera

ligaments