# Developing a Realistic and Cost-Effective Training Model (MaiSurge) for Laparoscopic Hysterectomies to Train and Assess Surgical Skill: Prospective Nonrandomized Controlled Trial

## TL;DR

A realistic and affordable training model for laparoscopic hysterectomies was developed and shown to improve surgical skills effectively.

## Contribution

A novel cost-effective 3D-printed training model (MaiSurge) for laparoscopic hysterectomy was developed and validated.

## Key findings

- Experts performed significantly better and faster on the MaiSurge model compared to novices.
- 92% of novices felt their surgical performance improved after training with the model.
- The model showed excellent interrater reliability and potential for skill assessment.

## Abstract

Laparoscopic surgery has a flatter learning curve compared to traditional open surgery. Therefore, structured programs and realistic training models are imperative to ensure patients’ safety. However, commercially available models are often too expensive or technically unrealistic for continuous surgical training.

The aim of this trial was to develop a cost-efficient and highly realistic uterus model to perform a total laparoscopic hysterectomy (TLH) and evaluate its applicability.

A training model (MaiSurge) for a TLH with salpingectomy or adenectomy was developed using a 3D printer and different cast materials. Polyvinyl alcohol was used to allow for the use of electrosurgery. To gather the first validity evidence, novice and expert gynecologists performed a TLH on the model. Operative time as well as surgical performance scores (Hysterectomy–Objective Structured Assessment of Technical Skills) were compared between both groups.

A total of 12 participants in the novice group and 18 participants in the expert group completed the simulation. The experts obtained significantly better modified Hysterectomy–Objective Structured Assessment of Technical Skills scores (mean 74.0, SD 12.9 vs mean 60.3, SD 14.9; P=.049) and performed significantly faster (median 69.5, IQR 49.5-74.3 minutes vs median 37.5, IQR 30.5-38.8 minutes; P<.001). An excellent interrater reliability was observed (intraclass correlation coefficient=0.91). Approximately 92% (11/12) of novices felt that they had improved their surgical performance after training on the MaiSurge uterus model. Overall, all participants agreed that the new MaiSurge uterus model should be integrated into training curricula to improve the performance of residents on TLHs.

A new highly realistic and cost-effective training model (MaiSurge) to perform a TLH was developed. The model distinguishes between good and poor laparoscopic performances and, thus, can be used in training as well as assessment of surgical skills. The possibility of simulating even complex laparoscopic procedures in a realistic environment may be an opportunity to train a future generation of gynecologists without compromising patient safety or exhausting the limited availability of operating room time.