Cystotomy Laboratory Simulation

Transcription

1 Kelli Braun MD, Robert Stager MD, Chadburn Ray MD, Bunja Rungruang MD Medical College of Georgia at Augusta University Note: This model can be used for Open Cystotomy Repair or Laparoscopic Cystotomy Repair. PREPARATION Station has two residents and a faculty preceptor Equipment per station: OPEN CYSTOTOMY REPAIR - One needle driver - One tissue forcep - One scissor - Two sutures - Velcro base for station - Simulation model (see below) LAPAROSCOPIC CYSTOTOMY REPAIR - Laparoscopic trainer - One laparoscopic needle driver - One laparoscopic grasper - One laparoscopic scissor - Two sutures - Laparoscopic trainer suture block - Simulation model (see below) Materials - Latex whoopee cushion (4 ¼-inch size) For mucosa - Non-adhesive shelf liner For muscularis - Glad Press n Seal For serosa - Foley catheter OR use a pipe cleaner and small common balloon For Foley catheter in - Velcro For attaching to simulation station - Scissors For cutting the defect - Black Sharpie marker For drawing the ureteral orifices in the mucosa - Spray fabric adhesive (works best) OR glue stick OR tape For attaching muscularis to

2 Bladder Mucosa Bladder Muscularis Serosa Setup and Assembly Steps 1. Cut shelf liner (muscularis) to fit the whoopee cushion () with cm extra around the circumference of the shelf liner. You should have 2 circles of shelf liner, one for each side of the whoopee cushion 2. Attach shelf liner (muscularis) to whoopee cushion () with spray fabric adhesive (works best) or a glue stick or tape. 3. Attach Press n Seal (serosa) over the circular portion of the whoopee cushion, folding it over the top of the whoopee cushion to cover both sides. Leave the small triangular portion of the whoopee cushion free (urethra) 4. Cut a defect across the top of the whoopee cushion, leaving a 3-cm opening at the top (dome of ). 5. Insert the Foley catheter tubing through the triangular portion of the whoopee cushion (urethra) and inflate the balloon. If you do not have a Foley catheter, then use a pipe cleaner and attach a small inflated balloon at the tip of the pipe cleaner to serve as a Foley catheter. 6. Using the Sharpie marker, draw a large dot on each side of the Foley catheter balloon on the posterior mucosa (inside the whoopee cushion) to represent the ureteral orifices.

3 1. Cut muscularis to fit 2. Attach muscularis 3. Attach Serosa 4. Cut defect at dome of Setup and Assembly for OPEN CYSTOTOMY REPAIR 1. Assemble the simulation model as above. 2. Assemble additional equipment for this station as listed above. 3. Attach Velcro to your simulation station (i.e. on table surface) and attach to the Velcro on the simulation model. Setup and Assembly for LAPAROSCOPIC CYSTOTOMY REPAIR 1. Assemble the simulation model as above. 2. Assemble additional equipment for this station as listed above. 3. Attach the simulation model to the large clip on the Velcro strip in the laparoscopic trainer box. 4. Place the red suture block for the laparoscopic trainer under the dome end of the to elevate this end for better visualization.

4 Model within trainer Model elevated Model with foley bulb LAB SEQUENCE OPEN CYSTOTOMY REPAIR 1. Assessment of knowledge of anatomy o Residents should be able to define the anatomy of the on this simulation model. o This should include a discussion of the location of the cystotomy defect in relation to the trigone and ureteral orifices. 2. Technical skill exercise: While one resident stabilizes the model if necessary, the primary resident for the task will perform a two-layer closure. Model can be stabilized on table using tape along the bottom portion and assist can help manipulate o The learner should describe the location of the defect. o The learner should describe the suture necessary to repair the defect. o The learner should repair the defect using a two-layer closure. The mucosa is closed in a single running layer using suture, a needle driver, and a tissue forcep. The muscularis is closed over the mucosal layer in a single running layer using suture, a needle driver, and a tissue forcep. o The learner should describe postoperative management of cystotomy repair. LAPAROSCOPIC CYSTOTOMY REPAIR 1. Assessment of knowledge of anatomy o Residents should be able to define the anatomy of the on this simulation model. o This should include a discussion of the location of the cystotomy defect in relation to the trigone and ureteral orifices. 2. Technical skill exercise: While one resident stabilizes the model if necessary, the primary resident for the task will perform a two-layer closure.

5 o The learner will describe the process of a timeout. o The learner will describe the proper positioning of a patient. o The learner will describe the proper set up of the camera equipment, tubing, and energy sources. o The learner will call for and properly identify the instruments used in the simulation: laparoscopic grasper and scissors. o The learner will describe the method upon which he/she would gain access to the abdominal cavity and obtain pneumoperitoneum. o The learner will describe safe secondary trocar placement and call for appropriate port sizes. o The learner will identify and describe key surgical anatomy. o The learner should describe the location of the defect. o The learner should describe the suture necessary to repair the defect. o The learner should repair the defect using a two-layer closure. The mucosa is closed in a single running layer using suture, a laparoscopic needle driver, and a laparoscopic grasper. The muscularis is closed over the mucosal layer in a single running layer using suture, laparoscopic needle driver, and a laparoscopic grasper. o The learner should describe postoperative management of cystotomy repair. Single layer closure 2 layer closure