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Simulation

Advanced Hysteroscopy

Simulation

Materials and Preparation

  • Station ideally has two residents and one faculty preceptor
  • Medical equipment per station:
    • Endoscopic tower
    • Hysteroscopic resection scope
    • Cutting electrodes bipolar
    • Monopolar reception loop
    • Electrosurgical Generators
    • 1000 cc bags 0.9% NaCl
    • 1000 cc bag sterile water
    • Tubing for inflow and out flow
    • Uterine model: can often be obtained from industry representative

About Models

  • Bell Pepper Model
  • Readily available
  • Inexpensive
  • During use stabilize by hand or taping to table
  • Use hysteroscopy sheath to bore hole (cervix)
  • Seeds can be grasped and extracted
  • Septum can be cut with scissors

Bell pepper model used in the diagnostic hysteroscopy simulation.

  • Commercial Models
  • Must be ordered
  • More expensive by reusable
  • Can simulate normal and pathological conditions
  • Example of a model below (courtesy of Limbs and Things)

Uterine model, courtesy of Limbs and Things.

Lab Sequence

The intended sequence of events for this lab involves two OSATS (observed structured assessment of technical skills):

  • 5 minutes for rectoscope assembly OSATS
  • 10 minutes for resection of intra-uterine pathology OSATS

For the OSATS all of the equipment and fluids should be laid out on the table and the resident must select and assemble all components correctly without faculty assistance.

The residents can select to use the monopolar or bipolar equipment but must match the appropriate fluid to the electrocautery equipment.

Competency Assessment

  • Resectoscope Assembly Component
    • Residents should be able to assemble the resectoscope correctly and identify the parts correctly in less than 5 minutes to be considered competent in this task.
    • Correct assembly and obtaining an image is necessary for competency.
    • Correctly naming and proper order of assembly will be noted as mastery of this task.
  • Endometrial Resection Component
    • Resident must:
      • Use the proper distention media based on device being used (0.9% NaCl if bipolar and sterile water if monopolar)
      • Resect at least one sub-mucosal fibroid using the appropriate drawback technique in under 10 minutes in order to be considered competent

Competency is obtained if all intrauterine landmarks and their location are noted, the proper distension media is used for the type of electrosurgery being employed and the pathology is excised.

Properly rotating the scope to maximize the use of the angled lens and minimize the torque of the cervix, resecting the fibroid even with the surrounding endometrial lining and proper use of the outflow channel to manage bubbles will be considered mastery of the lab.