Cervical bleeding with cervical stabilization during IUD placement: allis clamp versus single-tooth tenaculum, a randomized control trial.

OBJECTIVE: To evaluate whether the use of an atraumatic Allis clamp will result in less bleeding than the standard single-tooth tenaculum for cervical stabilization during intrauterine device (IUD) placement. METHODS: A single-blinded randomized controlled trial was conducted during insertions of IUDs between March 2017 and March 2018. University of Kentucky Institutional Review Board (IRB 16-1110-P3K) approval was obtained. Physicians were randomized to use either an Allis clamp or a single-tooth tenaculum for cervical stabilization. A post-procedure questionnaire was used to collect outcome measures as well as demographic and obstetric-related factors. RESULTS: Of the ninety-five participants, there was no difference in age, self-identified race/ethnicity, or the evaluated obstetric factors between the groups. Bleeding was present after clamp removal in 3 (6.3%) insertions using an Allis clamp and 26 (55.3%) insertions using a single-tooth tenaculum (RR = 0.113, CI = [0.037, 0.3481], p < 0.0001). There was no difference in IUD insertion success rates between the two clamps. There was no difference in the number of interventions needed to obtain hemostasis including indirect pressure, silver nitrate, monsel's solution, or stitch for hemostasis. Pain scores did not differ based on clamp type or age of patient, but were significantly different based on parity (p < 0.001) and IUD type (p < 0.003). CONCLUSION: Decreased incidence of bleeding from cervical stabilization device, with unchanged insertion success using the Allis clamp can be an alternative to the single tooth tenaculum in the procedure of IUD insertion. TRIAL REGISTRATION NUMBER: The trial was retrospectively registered on 1/11/22 (trial registration number NCT05187078).

Laparoscopic Major Vascular Injury Simulation Using a Synthetic Compared With Porcine Model.

BACKGROUND: Major vascular injury training may improve clinical skills and reduce patient morbidity during gynecologic laparoscopy; thus, reliable models for simulation should be identified. METHOD: Two laparoscopic major vascular injury simulations using synthetic or live porcine models were constructed. The primary surgeon was given the opportunity to complete both simulations. After obtaining peritoneal access, the surgeon quickly encountered a major vascular injury. Degrading vital signs and estimated blood loss coupled with the replay of a human heartbeat that increased in volume and intensity were provided to heighten tension during the synthetic simulation. EXPERIENCE: Twenty-two gynecologic surgery educators evaluated the simulations. Educators considered the porcine model superior to the synthetic model with regard to tissue handling. The synthetic model simulation was found to be equivalent to the porcine model on how likely the simulation would be able to improve performance in a clinical setting. Educators were more likely to implement the synthetic simulation over the porcine simulation. CONCLUSION: The synthetic model was found to be more feasible and as effective as the porcine model to simulate and teach the initial management steps of major vascular injury at laparoscopy by gynecologic educators.