Teaching the Retropubic Midurethral Sling Using a Novel Cadaver and Model-Based Approach

Abstract

Objective: To measure the impact of a model-based teaching program on resident comfort and skill with retropubic midurethral sling (MUS).

Study design: Residents were assessed before and after a retropubic MUS teaching session, which included a brief lecture and three interactive teaching stations (cadaver pelvis, retropubic MUS pelvic model, cystoscopy model). Self-assessment measures included MUS-related visual analog scale (VAS), Likert, and open-ended questions. Objective assessment measures were used to score blinded videos of trocar passage on a pelvic model, including a modified objective structured assessment of technical skills (mOSAT) and a retropubic MUS-specific checklist of surgical steps. Emerging themes from the open-ended questions were identified using grounded theory; analysis ceased once theme saturation was achieved.

Results: Twenty-five of 37 total residents participated in the training session and 24 participated in this study. Following training, VAS scores, Likert scores, and qualitative analysis indicated greater resident comfort with performing retropubic MUS, with relevant anatomy, and with trocar passage. Residents demonstrated improvement in model trocar passage post-training, with a rise in mOSAT score (47% to 65%; p = .01) and a rise in checklist score (61% to 75%; p = .11). Residents expressed discomfort due to inexperience with MUS, concern regarding trocar passage, and worry over potential complications. Residents reported feeling more prepared to perform MUS after the session. They stressed the importance of repetition and a comfortable learning environment for surgical training, and praised the "hands-on" training session.

Conclusion: We demonstrate success using a short, single-session, hands-on group training session to improve comfort and skill with retropubic MUS.

Keywords: midurethral sling; surgical simulation; surgical teaching.

Figure 1. Pelvic model for retropubic trocar passage

Figure 2. Hemisected cadaver pelvis demonstrating correct trocar placement

Arrows: Trocar/mesh track; BL: Bladder; PS: Pubic symphysis; R: Rectum; UT: Uterus.

Figure 3. Hemisected cadaver pelvis demonstrating trocar bladder perforation

Arrows: Trocar/mesh track; BL: Bladder; PS: Pubic symphysis; R: Rectum; UT: Uterus.

Figure 4. Study flow diagram

MUS: Midurethral sling.