Obliterated Posterior Cul-de-sac Laparoscopic Surgical Simulation

Abstract

BACKGROUND: Obliteration of the posterior cul-de-sac is a challenging, often unexpected surgical finding. Developing the dissection skills required to manage this finding during laparoscopy is essential for optimizing treatment of many pain disorders during hysterectomy or ovarian surgery; however, exposure of trainees to cul-de-sac dissection is variable. Currently, there are no widely available simulation models for teaching and practicing this technique. METHOD: Our aim is to design a low-cost and high-fidelity laparoscopic simulation model that represents key anatomical structures and emphasizes skills for laparoscopic dissection of an obliterated posterior cul-de-sac. EXPERIENCE: A three-dimensional model was created and is described. Nine experts (gynecologic surgery fellows and attendings) and 17 residents completed a single 30-minute simulation session and completed several assessments to begin establishing the face validity of this model. CONCLUSION: Experts and residents rated the obliterated cul-de-sac simulation as highly realistic and useful. Residents showed a statistically significant increase in comfort with the dissection, from a median Likert score of 1 out of 5 (interquartile range 1–1) to 3 out of 5 (interquartile range 2–3) (P<.001). Experts scored better than residents on blinded video grading of model performance (P<.001). This low-cost and easily reproducible model fills a critical gap in gynecologic surgery education.

Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

“…In addition, we also recognized that interns and probationers have certain [11]. The effects of the simulation training are obvious, but equally important is the evaluation during and after the training [12].…”