Investigating the Efficacy of Anatomical Silicone Models Developed from a 3D Printed Mold for Perineal Repair Suturing Simulation

Abstract

There is a scarcity of affordable, validated, standardized and anatomically correct silicone perineum models for the rehearsal of postpartum laceration repair. The purpose of this technical report is to describe and validate evidence for a silicone, perineal repair model created from a 3D printed mold for medical resident training and clinical skills maintenance. A pre-existing model from an open-source royalty-free website was purchased and converted using Fusion360^TM (Autodesk Inc., San Rafael, CA, USA) into a stereolithography (.stl) file and altered to produce a negative mold. Using a spatula, a fine silicone layer was first applied inside the mold, followed by a small piece of flesh-colored mesh netting material within the perineal surface area, fitting the width of the mold. The mesh was pressed into the thin layer of silicone, which was meant to provide anatomical structure to prevent the sutures from tearing through the silicone. The remainder of the silicone mix was then poured into the mold, which required three hours to fully set before being removed from the mold. Twelve silicone models were produced and used during a one-hour workshop at the Rural and Remote Conference by 16 obstetrics and gynecology residents and practicing rural physicians, and four facilitators. At the end of the workshop, the participants were provided with a qualitative survey and asked to rate the perceived realism and educational effectiveness of the silicone perineum model as compared to pre-existing simulation models that they have used previously. The overall workshop participant feedback was positive, noting that the models provided more realistic visualization for the suturing simulation of first- and second-degree perineal injuries. The silicone models were considered to be useful in simulation training when attempting first- and second-degreeperineum suturing techniques within a confined space. The overall feedback was positive, noting that they provided more realistic visualization experience compared to pre-existing simulation models, such as beef tongues and synthetic sponges. The feedback from the participants and facilitators included thoughts about how to add additional mesh to the silicone model so the subcutaneous and vaginal plane sutures would hold, as well as increase the size of the vaginal canal size to more accurately represent a postpartum repair. There were also suggestions to alter the colour of the model to be flesh-toned as opposed to pink, to more accurately simulate human tissue. Silicone perineum models, created from a 3D printed mold, are an economical training tool as compared to commercially available, cost prohibitive models. They also provide anatomically accurate simulation training opportunities for residents to learn and maintain clinical skills in perineal repair, as compared to beef tongues and synthetic sponges, which have previously been used in obstetrics and gynecology simulation-based medical education.

Keywords: 3d printing; gynecology; obstetrics; perineal repair; perineum; postpartum; simulation; surgery.

Figure 1. Perineum (.stl) model and custom 3D printed mold

Figure 2. Silicone perineum model from 3D printed mold and silicone perineum model with sutured laceration from workshop

Figure 3. Obstetrics and gynecology perineum suturing workshop at the Remote and Rural Conference on April 14, 2018

Figure 4. Beef tongue used for suturing simulation and silicone perineum model used for suturing simulation

Figure 5. Efficacy survey to measure the performance of the silicone models compared to the pre-existing models

Figure 6. Q2 and Q3 results from the workshop participant feedback survey

Y Axis: frequency of responses. X Axis: referring to the response anchors as related to each number respectively in Figure 5.

Figure 7. Q5 and Q6 results from the workshop participant feedback survey

Y Axis: frequency of responses. X Axis: referring to the response anchors as related to each number respectively in Figure 5.

Figure 8. Q7 and Q8 results from the workshop participant feedback survey

Y Axis: frequency of responses. X Axis: responses to questions 7 and 8. Referring to the response anchors as related to each number respectively in Figure 5.

Figure 9. Proposed progression of silicone perineum models, which includes first- and second-degree lacerations (v2) and third- and fourth-degree lacerations (v3)

Figure 10. Second iteration molds for first- and second-degree perineal model (green) and third- and fourth-degree perineal model (blue)

Figure 11. Second iteration of first- and second-degree perineal model and second iteration of third- and fourth-degree perineal model