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Simulation

Office Endometrial Biopsy

Simulation

Materials and Preparation

Tips

Answers to Common Questions

  • Remember that this is a simulation, nothing can be as exact as real-life, but this is a close approximation
  • Reiterate that what is important is the learner going through the steps of the procedure from start to finish, so they are more familiar with them when they actually do the procedure in the office

Common Pitfalls to Monitor

  • Getting a green papaya may make the biopsy more difficult. Try to make sure that the papayas are ripe.

Lab Sequence

  1. Assemble all of the equipment as described above
  2. Begin counseling the patient on all of the risks, benefits, and alternatives to procedure (if using a standardized patient, if not proceed to step 4)
  3. Conduct a timeout
  4. Bimanual exam for size/position of uterus (if using a hemipelvis with papaya) Insert speculum and clean cervix with betadine (if using hemipelvis with papaya)
  5. Insert the pipelle gently through the cervical os into the uterus until resistance is met (fundus)
  6. If unable to pass the pipelle through the os, place a tenaculum on the anterior portion of the cervix portion of the papaya
  7. If still unable to pass the pipelle, consider using a cervical dilator (e.g., Pratt dilator)
  8. Withdraw the inner piston/plunger of the pipelle to create a suction or vacuum
  9. Rotate and twist (corkscrew) the pipelle gently while moving the pipelle in and out through all quadrants of the uterine (papaya) cavity
    1. Once pipelle tube is filled with tissue, remove the pipelle and push the inner piston/plunger back into the pipelle tube to empty the endometrial sample into a formalin container
    2. Attempt multiple uterine passes with the pipelle. It may be needed to get an adequate specimen
    3. Make sure the tip of the pipelle does not touch the formalin if multiple passes are needed
  10. Once an adequate specimen is obtained, remove the tenaculum (if used)
    1. You would inspect the tenaculum site for bleeding in a live patient
  11. Remove speculum

Competency Assessment

Resident conducts a "time out." Resident performs bimanual exam, properly inserts speculum and visualizes cervix, cleans cervix, and inserts Pipelle gently through the os (places tenaculum if needed). Resident properly uses Pipelle to obtain adequate specimen.