A cost-effective model for training in Robot-Assisted Sacrocolpopexy.

BACKGROUND: The number of robotically assisted sacrocolpopexy procedures are increasing; therefore, experienced clinicians are needed. Simulation-based cadaver models are challenging in aspects of cost and availability. Therefore, we need to look at alternative and more cost-effective models. OBJECTIVE: The objective of this video was to design a new surgical model for the training of robotic-assisted sacrocolpopexy, which is affordable and accessible. METHODS: We used a whole chicken model to simulate the female pelvic floor. We used Medtronic's Hugo™ RAS system as the robotic console in that procedure. A vaginal cuff was prepared from the proventriculus (stomach), and a Y shaped mesh was secured to the ischium to simulate the sacrocolpopexy procedure. CONCLUSION: This model is easily constructed and in our view is cost-effective. We have demonstrated a new valuable education tool that can serve as a practical simulation model to teach the sacrocolpopexy procedure and to improve trainees' skills. A larger cohort study size is essential to demonstrate the learning curve among young trainees using this simulation model.

Anatomy of the pudendal nerve and its terminal branches: a cadaver study.

BACKGROUND: This study documents the anatomy of the pudendal nerve, which has a major role in maintaining faecal continence. Unexpected faecal incontinence can develop following perineal surgery even when the anal sphincters are not damaged. In addition, injury to the pudendal nerve might be encountered during pelvic procedures such as a sacrospinous colpopexy. METHODS: An anatomical study on 28 cadavers was conducted to examine the course of the pudendal nerve and its branches in the perineum. RESULTS: In five of the 28 cadavers dissected (four male, one female), a nerve plexus was found within the ischiorectal fossa in close proximity to the anal sphincters. The plexus received contributions from interconnecting branches of the inferior rectal and perineal nerves to innervate the external anal sphincter. In 11 of the 28 cadavers (five female, six male) an additional nerve arose from the medial aspect of the pudendal nerve at the level of the sacrotuberous and sacrospinous ligaments. This nerve continued distally and gave several branches to the perineum and the levator ani muscle. CONCLUSION: A sound knowledge of the anatomical variations of the pudendal nerve and its branches is essential for all surgeons operating in the perineal region.