The Dying Art of Vaginal Hysterectomy: A Novel Simulation

The rate of vaginal hysterectomy has decreased despite the procedure being the preferred hysterectomy method according to the American College of Obstetricians and Gynecologists (ACOG). Physicians have reported that some of the main barriers to performing minimally invasive hysterectomy are the size and shape of the uterus, difficulty of accessibility to the uterus, and surgeons' lack of training and experience. A simulation model for vaginal uterine morcellation was created in an effort to increase surgeons' confidence and to encourage them to select vaginal hysterectomy for their patients. The Conner model, where polyvinyl chloride (PVC) piping is used to simulate the pelvis and vaginal canal, was used as the basis for the pelvis. A medium-density fiberboard (MDF) was used as a base, while a PVC piping structure was used to stimulate the pelvis. The uterus was created from a peanut (car-wash) sponge that was carved into a triangle shape. The reusable MDF/PVC model was built in approximately one hour and cost under USD 30. The sponge uterus was built in approximately 10 minutes and cost under USD 2. Senior residents and faculty who have previously performed uterine morcellation participated in our simulation. Resident physicians reported that they felt more confident in their skills after the simulation. Both resident and staff physicians reported that the model had created a realistic experience. We created a novel model for vaginal uterine morcellation that was reported to be realistic in the initial investigation and increased confidence in the procedure for physicians. The model is easy to create, affordable, and partially reusable.