Low Fidelity Contained Manual Tissue Extraction Simulation Improves Resident Confidence [3H]

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Controversy surrounding power morcellators triggered an FDA warning resulting in multiple hospitals banning the device. Physicians have had to revert to alternate tissue extraction techniques for large specimens. We developed a simulation to allow physicians to practice contained manual tissue extraction.


We created a low fidelity simulator and filmed an instructional video depicting contained tissue extraction techniques. 4th year residents answered a questionnaire assessing their baseline exposure and confidence level with contained tissue extraction, then they each extracted a 355 g beef tongue specimen from our simulator while being timed. They then viewed the instructional video then once again extracted another 355 g beef tongue specimen. Following the simulation, they answered another survey question regarding their confidence level.


Six 4th year residents participated. Four had ever seen power morcellation, one had ever performed it, none had seen it in a contained fashion. Six had seen and performed manual morcellation vaginally, but never in a contained fashion. Two had seen and performed manual morcellation abdominally, only one performed it in a contained fashion. The mean confidence level with contained manual tissue extraction of a large specimen increased from 1.83 to 4.17 (SD 0.41, P=.001) with the intervention on a 5-point Likert scale. There was no statistically significant difference in tissue extraction timing.


Our residents are rarely exposed to morcellation techniques, particularly in a contained fashion. Among 4th year residents, this low fidelity simulation statistically significantly improved their confidence level in regard to contained manual tissue extraction of a large specimen.

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