A Cadaveric Simulation Model to Teach Suture Placement During Sacrospinous Ligament Fixation

The objectives of this study were to describe a cadaveric simulation model designed to teach sacrospinous ligament fixation (SSLF) and to assess trainee performance, comfort, and skill with suture placement.

Nine invited participants from 3 institutions participated in cadaveric simulation training, consisting of a didactic lecture, technical demonstrations, and supervised execution of suture placement. Trainee self-perceived knowledge and confidence levels of SSLF were assessed before and after the educational intervention. Suture placement was assessed by expert faculty pelvic reconstructive surgeons. The number of attempts required by trainees for an anatomically safe suture placement was recorded. Participants completed a postintervention satisfaction survey.

All 9 participants correctly identified where an SSLF suture should be placed on a printed image before the educational intervention, but only 33% achieved anatomically safe suture placement on the first attempt (mean ± SD, 2.88 ± 2.10 attempts). Four participants (44%) reported comfort with independently performing SSLF before the course. Of these, three (75%) required more than 1 attempt for successful suture placement. Mean ± SD distance of SSLF suture from the ischial spine was 1.90 ± 0.59 cm. All participants reported that they found the training helpful in learning the surgical steps and anatomy related to SSLF and would recommend it to others.

A cadaveric simulation teaching model led to improved trainee-reported confidence with the operative steps and anatomy related to SSLF. Participants' prior knowledge of procedural steps and anatomy did not always transfer to adequate procedural skills for safe suture placement, suggesting the need for further simulation practice for fellow trainees.