The effectiveness of simulation training for enhancing operative skills is well established. Here we describe the construction of a simple, low-cost model for teaching the loop electrosurgical excision procedure. Composed of common materials such as polyvinyl chloride pipe and sausages, the simulation model, shown in the accompanying figure, can be easily reproduced by other training programs. In addition, we also present an instructional video that utilizes this model to review loop electrosurgical excision procedure techniques, highlighting important steps in the procedure and briefly addressing challenging situations and common mistakes as well as strategies to prevent them. The video and model can be used in conjunction with a simulation skills laboratory to teach the procedure to students, residents, and new practitioners.
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Problem: lack of a durable, low-cost, realistic simulation model for teaching LEEP
The loop electrosurgical excision procedure (LEEP) is one of the most frequently performed procedures in gynecology. Although LEEP is a relatively simple procedure, it can be difficult to teach, and mastery requires deliberate practice. Previous studies have demonstrated the effectiveness of simulation training for increasing practitioners’ confidence and skill in performing operative procedures. In a prospective observational study, Hefler et al described a low-cost LEEP simulation model using porcine sausages and an empty yogurt cup that significantly improved participants’ operative performance. Although the model described by Hefler et al is useful, it is not ideal. In this instance, a good simulation model should be low cost, easy to assemble, durable, and realistic, accurately representing the most important challenges associated with the procedure. In addition, a sturdier, reusable model would allow for reproducible results with multiple simulation exercises.
Our solution
Our tabletop model provides a more realistic representation of the female pelvis and forces the surgeon to operate without moving or manipulating the model, similar to operating within the narrow confines of the vagina. Also, Hefler’s yogurt cup is easily damaged, whereas our construction uses more durable polyvinyl chloride (PVC) to create a model that can be reused indefinitely. Additionally, we have produced an instructional video that can be used along with the model in a LEEP skills laboratory. The Video demonstrates construction of the model and then uses it to review operative techniques, highlighting important steps in the procedure and briefly addressing challenging situations and common mistakes. The Video is freely available to educators for didactic purposes.
The materials required for this model can be found at any hardware store ( Figure 1 ). To assemble our model, we first drilled a hole in a 4 × 12 inch slab of particle board just large enough to accommodate the threaded end of a PVC adapter piece. The hole should be less than 2 inches from one end of the board so that the board does not interfere with speculum placement when the model is assembled. We inserted the adapter through the hole and screwed the T piece into place. Next, the fender washer (2.25 inches outside diameter) was glued onto the back opening of the T piece, and a sausage was inserted. Enough of the sausage should protrude through the back of the model to wrap an electrosurgical grounding pad around the end ( Figure 2 ).
Additional materials required for the LEEP simulation laboratory are listed in Figure 3 . We recommend using sausages with a lower fat content, such as turkey sausages, as they generally produce less smoke. Loop electrodes in a variety of shapes and sizes, including square and roller ball electrodes, should be available. Each sausage can be used multiple times to conserve resources. As other authors have noted, sausages provide an excellent representation of the uterine cervix, and experienced participants will notice that the tissue resistance is remarkably similar to that of cervical stroma.
