Marsupialization of Bartholin Abscess
- Four balloons
- Plastic cup (16 oz)
- Lotion/Redi whip cream for cyst fluid
- Duct tape
- Curved hemostat
1. Place the first balloon (cyst wall) over the Kelley clamps.
2. Slide a second balloon over top of the first balloon (vulvar epithelium).
3. Fill the inner balloon with choice of cyst fluid (lotion, Redi whip cream, etc.) and tie it closed.
4. Blow up the third balloon (opposite labia) until it just fits inside the plastic cup, then place the first balloon complex beside it within the cup.
5. Cut a fourth balloon and stretch it over the cup containing the two balloons.
6. Cut a small vertical slit in the fourth balloon, being careful not to puncture the inner balloons.
7. Turn cup on its side and tape to workspace.
Equipment for Marsupialization
- Disposable chucks
- Scalpel with 10, 11 or 15-blade
- Needle driver
- Hemostat curved x 2
- Suture scissors
- 3-0 delayed absorbable suture x 2
- 30 cc syringe with water or 10 cc saline flushes x 3
- Kidney basin
1. Simulate vaginal prep
2. Define the abscess border by palpation
3. Using the 11-blade, make a vertical incision, extending approximately 3 cm over the anterior abscess surface inside the vagina
4. Express the “pus” into the kidney basin and simulate break up loculations with a curved hemostat.
5. Grasp the two edges of the incision, making sure to incorporate both vaginal epithelium and cyst wall, with curved hemostats.
6. Irrigate the cyst cavity with a total of 30 cc.
7. Place 3 sutures per side to approximate the cyst wall to the vaginal epithelium.
Simulations Working Group Resources
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