Marsupialization of Bartholin Cyst and Abscess

Simulation

Marsupialization of Bartholin Abscess

Materials

Four balloons
Plastic cup (16 oz)
Lotion/Redi whip cream for cyst fluid
Duct tape
Curved hemostat

4 balloons, a pair of scissors, a 16 oz cup, and a bottle of lotion.

Model Set-up

1. Place the first balloon (cyst wall) over the Kelley clamps.

First step of model set-up. Place the first balloon over the Kelley clamps.

2. Slide a second balloon over top of the first balloon (vulvar epithelium).

Second step of model set-up. Slide a second balloon over top of the first balloon.

3. Fill the inner balloon with choice of cyst fluid (lotion, Redi whip cream, etc.) and tie it closed.

Third step of model set-up, continued. Fill the inner balloon with choice of cyst fluid (lotion, Redi whip cream, etc.). Tie the filled balloon 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.

Fourth step of model set-up. Blow up the third balloon until it just fits inside the plastic cup.

Fourth step of model set-up, continued. Place the first balloon beside the third balloon within the cup.

5. Cut a fourth balloon and stretch it over the cup containing the two balloons.

Fifth step of model set-up. 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.

Sixth and seventh step of model set-up. Cut a small vertical slit in the fourth balloon, being careful not to puncture the inner balloons. Turn cup on its side and tape to workspace.

Equipment for Marsupialization

Disposable chucks
Gloves
Scalpel with 10, 11 or 15-blade
Needle driver
Forceps
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
Model

Marsupialization Procedure

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

Step 3 of the marsupialization procedure. 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.

Step 4 of the marsupialization procedure. Express the pus into the kidney basin.

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.

Step 7 of the marsupialization procedure. Place 3 sutures per side to approximate the cyst wall to the vaginal epithelium.