Robert M. Dean, MD
Jasmin Hundal, MS IV
Azadeh Nasiri, MD
Michelle Sreter, MD
Materials and Preparation
- Foam sheet
- Baltic Birch board
- Dowels 3/8" x 12" 4 pack
- Duct Tape
- Foam cup
- Krylon spay glue can
- Redi whip cream can
- Endocavity sono probe covers
- Velcro tape
Model Set Up
- Start with a birch board ¼ x 6 x 12 inches.
- Drill 3 3/8th inch holes in a triangular shape. The base holes are 4 inches apart and the height is 1 ¼ inch.
- Cover the base with duct tape and puncture the three holes (duct tape makes cleaning easier).
- Take 3/8 x 12-inch dowels and cut them into 6-inch length.
- Insert the dowels into the holes.
- Take the Velcro strips and cut them into 4-inch lengths.
- Place one side on the Velcro on the foam cups
- Insert the foam cups on the dowel's upside down.
- Take the 12 x 18-inch foam sheets and cut them into 4 x 18-inch strips.
- Attach the other side of the Velcro to the edge of the foam strips.
- Fold the foam strip in half, Velcro to the outside and place it over the apex dowel.
- Wrap the foam strips around the outer edge of the foam cups attaching the Velcro strips.
- Create the abscess by unrolling the endocavity probe cover and filling the bottom two inches with Redi Whip. Keep the can upside down and place the tip and the very bottom of the probe cover in order to minimize air.
- Tie a knot in the probe cover, eliminating air.
- Spray the back side of the foam sheet and attach the "abscess" to the foam sheet, allow five minutes to dry.
- Spin the cups to align the abscess to approximate the medial edge of the vulva on either side.
- You can do 5 or 6 abscesses on one strip.
Equipment for Marsupialization
- Disposable chucks
- Gloves Scalpel-10,11,15
- Needle driver
- Hemostat curved x 2
- Suture scissor
- 3-0 delayed absorbable suture 30cc syringe with water
- Gauze or paper tissue
- Simulate prep
- Palpate abscess to define borders
- Make a vertical stab wound just lateral to the hymeneal ring starting in the upper 1/3 of the abscess and extend it down 3 cm
- Express the "pus" (Redi Whip) out
- Irrigate the abscess with normal saline in a 30cc syringe
- Use curved hemostat to break up loculations
- Using the curved hemostat, spread apart the incision so you can see the abscess cavity and clamp the edge you want to sew first in the midpoint
- Using a 3-0 Vicryl suture, place your middle suture by everting the lining of the cyst wall and approximating it to the vulvar epithelium
- Place one suture above and below on the same side
- Grasp the opposite side and repeat steps 7-9.
The CREOG Surgical Skills Task Force created this simulation as part of a standardized surgical skills curriculum for use in training residents in obstetrics and gynecology.