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