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Preoperative Simulation of Retropubic Midurethral Sling to Decrease Bladder Perforation Rate Among Obstetrics and
Nemi M Shah1, Maria E Florian-Rodriguez, Summer S Meinhardt1
1From the Department of Obstetrics and Gynecology.
Urogynecology (Philadelphia, Pa.)
|January 26, 2023
Summary
A training video and pelvic model simulation did not significantly reduce bladder perforations during midurethral sling procedures. While the perforation rate decreased by 35%, the intervention was not effective in improving surgical outcomes for residents.
Area of Science:
- Urogynecology
- Surgical Education
- Patient Safety
Background:
- Bladder perforation is a known complication of retropubic midurethral sling procedures.
- Surgeon experience reduces bladder injury rates, but training methods for novice surgeons are limited.
Purpose of the Study:
- To decrease bladder perforation rates in obstetrics and gynecology residents performing retropubic midurethral sling procedures.
- To evaluate the effectiveness of an instructional video and low-fidelity simulation for surgical training.
Main Methods:
- A baseline bladder perforation rate was established via retrospective chart review.
- A prospective educational intervention included a 10-minute video and preoperative simulation using a pelvic model.
- The intervention was implemented for residents on the urogynecology service from December 2017 to March 2020.
Main Results:
- A total of 215 retropubic midurethral sling cases were analyzed.
- The post-intervention bladder perforation rate was 6.5%, a 35% reduction from the pre-intervention rate of 10% (P=0.19).
- The training intervention was implemented in 89.8% of eligible cases.
Conclusions:
- The combination of an instructional video and preoperative low-fidelity simulation was not effective in reducing bladder perforations during tension-free vaginal tape procedures.
- High compliance with the training protocol did not translate to a statistically significant reduction in complications.
