Hysteroscopic Training Simulators – a quali6ve evalua6on and comparison of different modali6es C. Skelly , Minimal Access Fellow D. Morgan, Consultant Gynaecologist Department of Obstetrics & Gynaecology, Antrim Area Hospital, Bush Road, Antrim
INTRODUCTION
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METHODS
RESULTS
CONCLUSIONS
Outpa&ent Diagnos&c and Opera&ve Hysteroscopy is an evolving field within modern Gynaecological services. A range of challenging technical skills must be a@ained before competence is achieved. In the outpa&ent seBng, where pa&ents are fully alert, at least ini&al competence should be gained through appropriate hysteroscopic simula&on prior to direct pa&ent contact.
We sought to assess 3 hysteroscopic training modali&es during a one day 36 delegate Prac&cal Hysteroscopy Workshop in January 2019 -‐ ProDelphus Hysteroscopy and Resectoscopy Simulator, ‘Limbs and Things’ Hysteroscopic trainer, and Smith and Nephew Truclear SIM. Delegates included nurse hysteroscopists, gynaecology trainees, speciality doctors and consultants. Delegates rotated through simula&on sta&ons manned by experienced Hysteroscopists or Industry Representa&ves, focusing on outpa&ent morcella&on; fluid management systems and use of mini-‐resectoscope; vaginoscopy and use of hysteroscopic instruments. They then provided equipment feedback.
Truclear SIM provides realis&c imaging, with graphics represen&ng pathology, from polyp to mul&ple fibroids. The program assesses competence, providing a score. There is no tac&le feedback, and no septum resec&on op&on. 84% of delegates rated it ‘excellent’, 8% ‘very good ‘, 8% ‘good’. (Figure 1)
Truclear SIM SIM Performance Feedback
Pro Delphus provides an ar&ficial uterus with capacity for biological implants. It requires ‘no touch’ vaginoscopic technique -‐ a vital skill in outpa&ent hysteroscopy; and realis&c pathologies – polyp, septum, myoma, also admiBng biological &ssue. It responds accordingly to fluid pressure changes and set pressures, making it a valuable resource for resec&on training. It is priced £1250 and is reuseable. 94% of delegates rated it ‘excellent’, 6% ‘very good’. (Figure 1)
ProDelphus Hysteroscopic simulator ProDelphus uterus with Type 0 and 1 myomas
‘Limbs and Things’ Hysteroscopic trainer provides a training system for diagnos&c hysteroscopic technique, and permits the inser&on, manipula&on and removal of instruments. Set-‐up is simple. It is non-‐biological therefore avoiding hygiene issues. Its use can be long-‐las&ng when only used for diagnosis and examina&on. 16% delegates rated it as ‘excellent’, 36% as ‘very good’, 48% as ‘good’. (Figure 1)
A range of hysteroscopic simula&on devices are available. When used in a rota&onal prac&cal worshop seBng, they can complement eachother posi&vely, providing a comprehensive overview of outpa&ent hysteroscopic techniques, resul&ng in posi&ve delegate feedback. The Truclear SIM demonstrates the concept of morcella&on without providing realis&c tacile feedback. The Prodelphus model is expensive, can represent technical difficul&es in terms of inser&ng biological &ssue and hygiene issues, but is reuseable and provides realis&c resectoscope training. ‘Limbs and things’ is less expensive however provides a less elaborate training system, suitable for demonstra&ng basic hysteroscopic techniques. All of these devices can play an integral role in educa&on and simula&on prior to direct pa&ent contact.
‘Limbs and Things’ Hysteroscopic uterus
Delegate feedback ra6ngs for Simula6on modali6es
Figure 1