Tissue Handling and Dissection

• Heavy duty grouting sponge (7.5x 5.25-inch x 2.25 inch)
• Freeze pops (Fla-Vor-Ice)
• Cotton bunting
• Spray adhesive (Flex Seal Clear)
• 3/8-inch diameter rope
• Multipurpose sealing wrap (Glad Press’n seal)
• Corkboard or plastic platform
• Plastic spring clips

• Metzenbaum scissors
• Debakey or tissue forceps without teeth
• Tissue retractors for retraction of the ureter

1. Cut sponge in half to create base of pelvic sidewall.
2. Wrap one freeze pop in press-n-seal wrap (“artery”).
3. Place two freeze pops (one wrapped “artery” and one regular freeze pop “vein”) at junction of sponge (Figure 1).
4. Cover “vessels” with cotton bunting (Figure 2).
5. “Ureter” preparation: rope placed between two layers of heavy duty press-n-seal saran wrap (Figure 3).
   

   

   

   

6. Spray cotton bunting with adhesive and place ureter preparation over vessels/pelvic sidewall (Figure 4).
7. Use clips to secure saran wrap to sponge and secure sponge to platform (Figure 5).

Lab

1. The learner should describe all anatomy of the pelvic sidewall
2. The learner should be able to perform the following techniques as demonstrated below:
   1. “grasp and tent”
   2. “push and spread”
   3. “gentle teasing/blunt dissection”
   4. “mm by mm” sharp dissection
   5. “skeletonization”
   6. demonstration of venous injury with leak from freeze pop vessel
3. The learner should describe techniques to control hemostasis and repair after a venous injury

1. The learner should describe the anatomical relationships of the pelvic sidewall prior to beginning dissection.
2. The learner should demonstrate:
   1. Appropriate grasping of tissue with the tissue forceps
   2. Appropriate orientation of the Metzenbaum scissors
   3. The “grasp and tent” technique shown for entry to the retroperitoneal space
   4. The “push and spread” technique show to release the areolar tissue of the pelvic sidewall
   5. The “gentle teasing/blunt dissection” for further dissection
   6. The “mm by mm” sharp dissection technique to mobilize the ureter
   7. The “skeletonization” shown for continued isolation of the ureter
   8. Creation of a venous injury with leak from freeze pop vessel
3. The learner should describe appropriate hemostasis methods of the pelvic sidewall with routine dissection and with venous injury

• 8-inch diameter plastic planting pot
• Heavy-duty scrub sponge (Scotch-Brite 4.5x2.7-inch by 0.6 inch)
• Corkboard or plastic platform
• Plastic spring clips

• Disposable scalpel
• Metzenbaum scissors
• Debakey forceps or tissue forceps without teeth
• Alice clamps or hemostats 
• Needle driver and suture

1. Cut parallel slits on side of plastic planter pot (Figure 1)
2. Secure sponge to side of planter pot using clips (Figure 2)
3. Secure pot to corkboard base (Figure 2)
4. Secure base to table top (Figure 2)
5. Sponge can be moistened with spray bottle to simulate tissue moisture (Figure 3)

Lab

1. The learner should describe appropriate surgical situations when anterior wall dissection is necessary including what pelvic exam findings that may be present to determine need for repair
2. The learner should perform the following techniques as demonstrated below:
   1. learner assessment image
   2. midline incision demonstration 
   3. “push and spread” 
   4. “traction/counter-traction” 
   5. “mm by mm” sharp dissection
3. The learner should describe and how appropriate repair of an anterior vaginal wall defect is performed and simulate closure with a needle and suture

1. The learner should describe the anatomical relationships of the anterior vaginal wall
2. The learner should demonstrate:
   1. midline incision of the “vaginal wall” with appropriate handling of the scalpel and tissue forceps
   2. the “push and spread” technique
   3. “traction/counter-traction”
   4. “mm by mm” sharp dissection
3. The learner should describe simulated closure of the anterior wall to complete an anterior repair
4. The learner should describe ways to control hemostasis of the anterior vaginal wall after dissection and repair