Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

Cassandra Presti,Conway Xu,S Abbas Shobeiri,Chang Liu,Francine Mcleod,Lauren Scott,Larry Walker

doi:10.4236/ojog.2021.119114

Abstract

Objectives: Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% - 0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities. The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. Methods: This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. Results: Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p Conclusions: Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions.

Highlights

Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% - 0.80% of procedures [1] [2] [3]
Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room
With the significant implications in mind when bladder injuries do occur, this study demonstrated that the cadaver surgical skills training curriculum greatly improved residents’ knowledge, surgical skills, and confidence to properly identify and repair bladder injuries

Summary

Introduction

Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% - 0.80% of procedures [1] [2] [3]. The most common injuries are to the bladder, accounting for 52% - 75% of all urologic injuries [1] [2]. Appropriate identification, evaluation, treatment, repair, and follow-up by gynecologic surgeons are important to reduce the long-term morbidities associated with bladder injuries, including infection, fistulas, and renal damage [1] [2] [5]. The general Obstetrician-Gynecologist (OBGYN) should be capable of selecting appropriate treatment based on size and location of injury including expectant management, prolonged use of a foley catheter, double-layer repair with delayed absorbable suture, or consultation with a urogynecology or urology specialist [3] [6] [7]

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Discussion

Conclusion