title: A novel and inexpensive vaginal hysterectomy simulator.
abstract: BACKGROUND
  The number of vaginal hysterectomy procedures performed by resident physicians in the United States is highly variable, with half of residency graduates completing 18 procedures or fewer as primary surgeon. Complex anatomy and technical challenge contribute to a steep learning curve for novice surgeons. Surgical simulation may be a useful adjunct to this surgical training, but a vaginal hysterectomy simulator is not currently available.
  
  
  METHODS
  We describe the construction of a vaginal hysterectomy simulator that prioritizes low cost, wide availability of materials, and ease of assembly. Initial construction and per-use simulation costs were calculated. Per-use preparation time was recorded. Surgical learners who used the simulator (n = 12) completed a survey to determine its contribution to their learning.
  
  
  RESULTS
  Total cost per simulation was US $1.83 after an initial US $103.79 investment in a resin bony pelvis and stand. All relevant major anatomic landmarks (ureter, bladder, uterus, cervix, vesicouterine fold, vagina, and posterior cul-de-sac) were represented. Of the 12 surveyed surgical learners, 9 (75%) responded. On a 10-point scale (10 = highest), respondents noted that the simulator positively contributed to knowledge of procedure steps (8.3), anatomic relationships (7.7), preprocedure confidence with the first vaginal hysterectomy as primary surgeon (8), and overall learning on how to perform a vaginal hysterectomy (8.3).
  
  
  CONCLUSIONS
  This technical report details the construction of a vaginal hysterectomy simulator, the individual parts, the cost of each part, and the results of a blinded survey of resident physicians who used the simulator during their vaginal hysterectomy instruction.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, School of Medicine, University of Missouri, 500 N Keene St, Suite 400, Columbia, MO 65201, USA. barrier@health.missouri.edu
authors.forename: Breton F
authors.initials: BF
authors.lastname: Barrier
authors.forename: Amy B
authors.initials: AB
authors.lastname: Thompson
authors.forename: Michael W
authors.initials: MW
authors.lastname: McCullough
authors.forename: John A
authors.initials: JA
authors.lastname: Occhino
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004867:Equipment Design; D005260:Female; D005836:Genitalia, Female / Q000033:anatomy & histology / Q000601:surgery; D006176:Gynecology / Q000193:education*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000193:education* / Q000379:methods; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008953:Models, Anatomic; D017145:Models, Educational; D010388:Pelvis / Q000033:anatomy & histology / Q000601:surgery; D015397:Program Evaluation