Background
Simulation is an important adjunct to traditional surgical training, allowing for
repetitive practice of new skills without compromising patient safety. Although several
simulation models have been described and evaluated for gynecologic procedures, there
is a lack of such models for laparoscopic myomectomy.
Objective
This study aimed to design a low-cost, low-fidelity laparoscopic myomectomy simulation
model and to assess the model’s validity as a training tool.
Study Design
The model was constructed using a “cup turner” foam cylinder, felt, a 2-inch stress
ball, self-adhesive bandage wrap, multipurpose sealing wrap, red marker, and hook-and-loop
fastener. Participants were recruited at a quaternary care academic center and at
the Society for Gynecologic Surgeons Annual Scientific Meeting. The simulation task
involved the following 2 steps: fibroid enucleation and hysterotomy repair. Validity
evidence was collected by comparing expert and novice simulation task performances.
Video recordings were scored by 2 blinded reviewers using the Global Operative Assessment
of Laparoscopic Skills scale (5–20 points) and a modified Global Operative Assessment
of Laparoscopic Skills scale (5–35 points), incorporating 3 novel domains specific
to laparoscopic myomectomy. The Mann–Whitney U test was used to compare the task completion times and performance scores. Interrater
reliability of scoring was assessed using the interclass correlation coefficient.
Validity was also assessed with a post-task survey regarding the model’s realism,
utility, and educational effect.
Results
The total cost to construct each model was under $5. A 3:1 ratio was used to recruit
15 novices and 5 experts. The median time to task completion was shorter for experts
than for novices (11.8 vs 20.1 minutes; P=.004). The experts scored higher than the novices on both the Global Operative Assessment
of Laparoscopic Skills scale (median 19 [range 13–20] vs 10 [6–17.5]; P=.007) and the modified Global Operative Assessment of Laparoscopic Skills scale (31.5
[21.5–33.5] vs 18.5 [13.5–32]; P=.009). The interclass correlation coefficient was 0.95 for the Global Operative Assessment
of Laparoscopic Skills scores and 0.96 for the modified Global Operative Assessment
of Laparoscopic Skills scores. Most of the participants agreed that the model closely
approximated the feel of fibroid enucleation (70% [14/20]) and suturing the uterus
(80% [16/20]). All the participants agreed that the model was useful for learning
or teaching laparoscopic myomectomy.
Conclusion
This study demonstrates evidence supporting the validity of a novel, low-cost laparoscopic
myomectomy model and a novel assessment scale for laparoscopic myomectomy training.
This simulation model provides a targeted training tool that allows learners to focus
on the key aspects of laparoscopic myomectomy and may improve readiness for the operating
room.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ob/Gyn resident self-perceived preparedness for minimally invasive surgery.BMC Med Educ. 2020; 20: 185
- The obstetrics and gynecology milestone project.J Grad Med Educ. 2014; 6: 129-143
- Factors that influence applicants pursuing a fellowship in minimally invasive gynecologic surgery.J Minim Invasive Gynecol. 2020; 27: 1070-1075
- Techniques of laparoscopic myomectomy.Reprod Biomed Online. 2011; 23: 34-39
- Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: a systematic review and meta-analysis.Am J Obstet Gynecol. 2022; ([Epub ahead of print])
- Effect of validated skills simulation on operating room performance in obstetrics and gynecology residents: a randomized controlled trial.Obstet Gynecol. 2013; 121: 578-584
- Validating a standardized laparoscopy curriculum for gynecology residents: a randomized controlled trial.Am J Obstet Gynecol. 2016; 215: 204.e1-204.e11
- Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence.Acad Med. 2011; 86: 706-711
- Randomized controlled trials: a systematic review of laparoscopic surgery and simulation-based training.Glob J Health Sci. 2014; 7: 310-327
- Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial.Am J Surg. 2010; 199: 115-120
- Comparing surgical experience and skill using a high-fidelity, total laparoscopic hysterectomy model.Obstet Gynecol. 2020; 136: 97-108
- Use of the limbs and things hysterectomy model to describe the process for establishing validity.J Minim Invasive Gynecol. 2018; 25: 1051-1059
- Development and validation of a laparoscopic simulation model for suturing the vaginal cuff.Obstet Gynecol. 2015; 126: 27S-35S
- Development and validation of a simulation model for laparoscopic colpotomy.Obstet Gynecol. 2018; 132: 19S-26S
- Development and validation of a laparoscopic hysterectomy cuff closure simulation model for surgical training.Am J Obstet Gynecol. 2016; 214: 392.e1-392.e6
- Description and validation of the Pelv-Sim: a training model designed to improve gynecologic minimally invasive suturing skills.J Minim Invasive Gynecol. 2008; 15: 707-711
- Implementation and validation of a retroperitoneal dissection curriculum.Am J Obstet Gynecol. 2018; 219: 395.e1-395.e11
- Obliterated posterior cul-de-sac laparoscopic surgical simulation.Obstet Gynecol. 2021; 138: 95-99
- Validation of educational assessments: a primer for simulation and beyond.Adv Simul (Lond). 2016; 1: 31
- A global assessment tool for evaluation of intraoperative laparoscopic skills.Am J Surg. 2005; 190: 107-113
- Development and validation of a ureteral anastomosis simulation model for surgical training.Female Pelvic Med Reconstr Surg. 2013; 19: 346-351
- Surgeon volume in benign gynecologic surgery: review of outcomes, impact on training, and ethical contexts.J Minim Invasive Gynecol. 2019; 26: 279-287
- Incorporating simulation into gynecologic surgical training.Am J Obstet Gynecol. 2017; 217: 522-526
- Creation and piloting of a model for simulating a minimally invasive myomectomy.Cureus. 2019; 11: e4223
- Virtual reality training improves operating room performance: results of a randomized, double-blinded study.Ann Surg. 2002; 236: 458-463
- Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies.Am J Surg. 2007; 193: 797-804
- “Case Log Information: Obstetrics and Gynecology.” 2021.(Available at:)https://www.acgme.org/globalassets/pfassets/programresources/obgyncaseloginfo.pdfDate accessed: December 13, 2021
Article info
Publication history
Published online: April 27, 2022
Accepted:
April 25,
2022
Received in revised form:
April 14,
2022
Received:
December 31,
2021
Footnotes
The authors have the following disclosures outside the area of the submitted work: I.C.G. has received a nonrestricted medical education grant from Intuitive Surgical. S.A.S. is a member on the advisory board for Myovant and receives royalties as a contributor for UpToDate. M.T.S. is a consultant for Applied Medical. K.N.W. is a consultant for Hologic, Karl Storz, and Aqua Therapeutics. M.D.T. is a consultant for Medtronic, Heracure Medical, and Ethicon. The remaining authors report no conflict of interest.
No funding was received for this study.
Cite this article as: Schneyer R, Molina A, Green I, et al. Development and validation of a simulation model for laparoscopic myomectomy. Am J Obstet Gynecol 2022;227:304.e1-9.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
