[Providing of a virtual simulator perineal anatomy (Pelvic Mentor®) in learning pelvic perineology: results of a preliminary study]

Pelvic + Anatomy: A new interactive pelvic anatomy model. Prospective randomized control trial with first-year midwife residents

Detailed knowledge of female pelvic floor anatomy is essential for midwifery and other professionals in obstetrics. Physical models have shown great potential for teaching anatomy and enhancing surgical skills. In this article, we introduce an innovative physical anatomy model called "Pelvic+" to teach anatomical relationships in the female pelvis. The Pelvic+ model's value was compared to a traditional lecture in 61 first-year midwifery students randomly allocated to either the Pelvic+ (n = 30) or a control group (n = 32). The primary outcome measure was a quiz comprised of 15 multiple choice questions on pelvic anatomy. Participants were assessed at baseline (Pre-Test), upon completion of the intervention (Post-Test1) and 4 months afterward (Post-Test2). Satisfaction with the approach was assessed at Post-Test1. Increase in knowledge was greater and the approach more accepted among resident midwives when Pelvic+ was used instead of standard lectures. Four months after the intervention, the improvement in knowledge was preserved in the Pelvic+ group. This randomized study demonstrates that the Pelvic+ simulator is more effective than classical learning for pelvic anatomy education, and offers a higher level of satisfaction among students during the educational process. Medical students training in obstetrics and gynecology, or any professional who specializes in the female pelvic floor might also benefit from incorporation of the Pelvic+ model into their training program.

3D Models of Female Pelvis Structures Reconstructed and Represented in Combination with Anatomical and Radiological Sections

We present a computer program designed to visualize and interact with three-dimensional models of the main anatomical structures of the female pelvis. They are reconstructed from serial sections of corpse, from the Visible Human project of the Medical Library of the United States and from serial sections of high-resolution magnetic resonance. It is possible to represent these three-dimensional structures in any spatial orientation, together with sectional images of corpse and magnetic resonance imaging, in the three planes of space (axial, coronal and sagittal) that facilitates the anatomical understanding and the identification of the set of visceral structures of this body region. Actually, there are few studies that analysze in detail the radiological anatomy of the female pelvis using three-dimensional models together with sectional images, making use of open applications for the representation of virtual scenes on low cost Windows® platforms. Our technological development allows the observation of the main female pelvis viscera in three dimensions with a very intuitive graphic interface. This computer application represents an important training tool for both medical students and specialists in gynecology and as a preliminary step in the planning of pelvic floor surgery.

[Urogynecology pelvic organ prolapse French surgical training during and after residency]

OBJECTIVES

For the treatment of prolapse, the vaginal route is less standardized than laparoscopy and seems abandoned by younger doctors. Our objectives were to evaluate the surgical experience of resident and youth gynecology and obstetrics assistants in pelviperineology and the level of confidence and mastery of the different surgical treatment of pelvic.

METHODS

An anonymous questionnaire sent via an Internet platform interviewing residents and young assistants of gynecology and obstetrics (promotion 2005 to 2010) in France on their surgical training in pelviperineology.

RESULTS

Twenty-nine percent (208/724) of the persons contacted responded with two thirds of residents and one third of young assistants, all regions of France were represented. Sixty-four percent of respondents wanted to favor a surgical career. The laparoscopic sacrocolpopexy was declared to be the best method mastered while residents and young assistants reported being more often leading operator in vaginal techniques during their medical training.

CONCLUSION

Surgical practice during medical training of resident and young assistants did not seem associated with declared mastery level of technique. Different clinical surgical practice training techniques such as simulation, cadaveric study, movies on surgical technics may also improve the level of confidence and mastery of young doctors for surgical techniques.

[Contribution of a virtual hysteroscopic simulator in the learning of hysteroscopic myoma resection]

OBJECTIVES

Uterine myomas are a frequent pathology affecting 20% of women of reproductive age. Myomas induce abnormal uterine bleeding, pelvic pain and increase the risk of infertility and obstetrical complications. Symptomatic sub-mucosal myomas are classically treated by hysteroscopic resection. Simulation is a method of education and training. It could improve quality and security of cares. The aim of this study is to assess the interest of a hysteroscopic simulator for the resection of myoma by novice surgeons.

METHODS

Twenty medical students were recruited, in a prospective study, in august 2014. The virtual-reality simulator VirtaMed HystSim™ (VirtaMed AG, Zurich, Switzerland) was used to perform the hysteroscopic training. All students received a short demonstration of myoma resection. The practice consists of a submucous myoma type 0 resection. The procedure and the evaluation were performed before and after a specific training in hysteroscopic resection of sixty minutes long. The main outcome criteria were time for the resection before and after training. The second criteria were fluid quantity used, number of contact between optic and uterine cavity and uterine perforation.

RESULTS

Twenty students aged from 22 to 24 years were included. The time for the procedure was significantly reduced after training (170s versus 335s, P<0.01). There is the same for fluid quantity used (335 mL versus 717mL, P<0.01) and the number of contact between optic and uterine cavity (0.2 contact versus 3, P=0.012). No perforation occurred in the simulation.

CONCLUSION

The results suggest that hysteroscopic simulator enhances and facilitates hysteroscopic resection for novice surgeons.