Can a Low-Fidelity Surgical Model Simulating Loss of Vessel Control During Uterine Artery Ligation Induce Stress Among Gynecologic Residents?

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Low-fidelity surgical simulation models are being used more often in surgical education. It is unclear whether or not residents have the same stress level during low-fidelity simulations compared to an actual surgery.


The low-fidelity uterine artery ligation simulator was fabricated with a 3D printed model uterus and consists of materials to form the cardinal ligament and tubing to fabricate functioning uterine arteries. The resident filled out a pretest questionnaire which assessed their perceived or actual stress level (1–4) while losing control of the uterine artery during an abdominal hysterectomy. The residents then performed ligation of the uterine artery on the model with instructions to control any bleeding that occurred. The experimental model simulated bleeding of the uterine artery independent of their ligation technique. The residents controlled the bleeding and then filled out a post-test questionnaire measuring their stress level during the simulation.


The results were evaluated by calculating the average difference between the residents pre and post-test subjective stress level. This difference was then compared via t test with zero (the expected average difference if the stress level was equal). The average difference was 1.11 (P<.0001), standard error or 0.1.


On average, the residents reported one less level of stress after the low-fidelity simulation than they perceived they would feel or have felt during an actual surgery. This model was unable to induce the stress that is likely to be encountered in a similar situation in a real surgery.

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