Get "real" with hysteroscopy using the pig bladder: a "uterine" model for hysteroscopy training

<p><b>INTRODUCTION</b>This study aimed to develop a realistic and lifelike uterine model for the training of hysteroscopy skills.</p><p><b>MATERIALS AND METHODS</b>A lifelike "uterine" model was constructed using female pig bladder. The pig bladder was enclosed within a malleable mould, with both ureters blocked by pins. Both rigid and flexible hysteroscopes were used in this study.</p><p><b>RESULTS</b>Basic diagnostic hysteroscopy can be performed in the usual fashion using this lifelike model. The cost of each learning station is minimal. Pig bladder accurately simulates the human uterus with its realistic tactile feel, and conditions in the surgical environment, including obscuration of vision by debris, uterine "folds", realistic "ostia", incomplete shearing of tissue, "uterine" perforation, etc.</p><p><b>CONCLUSION</b>This low-cost novel model provides realistic tissue resistance and yields an almost anatomically accurate hysteroscopic training tool, thereby allowing trainees to effectively acquire both diagnostic and therapeutic hysteroscopic skills.</p>

Gynaecologic robot-assisted cancer and endoscopic surgery (GRACES) in a tertiary referral centre

<p><b>INTRODUCTION</b>Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.</p><p><b>MATERIALS AND METHODS</b>A review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.</p><p><b>RESULTS</b>Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.</p><p><b>CONCLUSION</b>Our caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery - basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.</p>

An unexpected presentation of endometriosis--a "parasitic" cyst of the bowel in a menopausal woman on hormone therapy

<p><b>INTRODUCTION</b>This report describes a "parasitic" endometriotic cyst of the small bowel.</p><p><b>CLINICAL PICTURE</b>A menopausal woman with a pelvic mass presenting years after commencing hormone therapy.</p><p><b>TREATMENT</b>We performed laparoscopic excision of a cystic tumour attached to the small bowel with a solitary vascular pedicle.</p><p><b>OUTCOME</b>Histology confirmed it to be an endometriotic cyst of ovarian origin, probably resulting from spillage during previous surgery and reactivation with hormone therapy.</p><p><b>CONCLUSIONS</b>We discuss the possible aetiology of this unusual presentation of endometriosis and review the literature on parasitic gynaecological tumours.</p>