Journal of Minimally Invasive Gynecology | 2019
1997 The Usefulness of Uterine Manipulation Simulation Among Ob-Gyn Residents as Bottom Person Prior to Assisting a Total Laparoscopic Hysterectomy: A Quirino Memorial Medical Center Experience
Abstract
Study Objective To determine the usefulness of uterine manipulation in a simulator prior to assisting as bottom person during total laparoscopic hysterectomies (TLH) among OB-GYN residents of Quirino Memorial Medical Center. Design Single-blinded Randomized Controlled Trial. Setting Quirino Memorial Medical Center with Residency Training in OB-GYN Patients or Participants Thirty-three obstetrician-gynecologic residents with no background on laparoscopy but assisting and performing gynecological laparotomy cases. Patients were female with age ranged of 20 to 55 years old, history of sexual contact, scheduled for elective total laparoscopic hysterectomy and adnexectomy for benign uterine or ovarian pathologies. Interventions The residents were randomly grouped into two. Group A consisted of sixteen residents who underwent uterine manipulation training using the pelvic trainer box and Group B consisted of seventeen residents who did not undergo training. Group A was given PST which were performed in 5 repetitions in one session. One set of tasks commanded to perform in this order were antevert uterus, uterus to the patient s left, uterus to the patient s right, push uterus cephalad, pull uterus caudally and retrovert uterus. One session consisted of 5 sets. After a week, both groups were asked to scrub-in on actual procedure with the same instructor commanding the tasks and recording the time to perform the tasks. Measurements and Main Results Group A performed the procedure-specific tasks correctly with a significantly shorter time than Group B (p-value of 0.000). The senior residents did not perform the PST better than the junior residents (correlation coefficient was significant with p-value of 0.023 and a negative correlation coefficient of -0.200, this means that as the negative time difference to perform from the first to the fifth specific tasks increases, the actual time decreases). Conclusion We have shown that uterine manipulation exercises in the pelvic trainer box is effective in the proper performance of residents as bottom person for uterine manipulation during TLH.