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Robotic Sacrocolpopexy Simulation Model and Associated Hierarchical Task Analysis

Myers, Erinn M., MD; Anderson-Montoya, Brittany L., PhD; Fasano, Heather T., MS; Vilasagar, Smitha, MD; Tarr, Megan E., MD, MS

doi: 10.1097/AOG.0000000000003218
Contents: Medical Education: Procedures and Instruments

BACKGROUND: There are limited robotic dry lab training resources that include presacral dissection with vaginal and sacral mesh attachment for robotic sacrocolpopexy. Our objective was to create a simulation model to resemble the anatomy encountered during robotic sacrocolpopexy. Additionally, we sought to outline the steps required to complete a robotic sacrocolpopexy by performing a hierarchical task analysis. With the results of the hierarchical task analysis, we assessed the model's ability to provide an adequate platform for completion of robotic sacrocolpopexy procedural steps.

METHOD: This observational simulation study was divided into two phases. Phase 1 included model development. Phase 2 involved development of the hierarchical task analysis and assessment of the model.

EXPERIENCE: After model creation, six experts each performed a robotic sacrocolpopexy using the model. Overall, experts agreed that the model replicated opening the peritoneum, presacral dissection, suturing on the anterior and posterior vagina, and presacral mesh attachment.

CONCLUSION: We demonstrate construction and use of a robotic sacrocolpopexy simulation model to aid surgeons in training. Further, the hierarchical task analysis provides a method to assess the model's ability to replicate each step of robotic sacrocolpopexy.

A simulation model was able to replicate the steps of presacral dissection with vaginal and sacral mesh attachment at the time of robotic sacrocolpopexy.

Department of Obstetrics and Gynecology and Carolinas Simulation Center, Atrium Health, Charlotte, North Carolina.

Corresponding author: Erinn M. Myers, MD, 2001 Vail Avenue, Suite 360, Charlotte, NC 28207; email:

Supported by internal institutional funding from Research Innovation and Carolinas HealthCare Foundation.

Financial Disclosure All of the following co-authors hold a patent: Erinn M. Myers, Brittany L. Anderson-Montoya, Heather T. Fasano, Smitha Vilasagar, and Megan Tarr, “Pelvic Model for Robotic, Laparoscopic, and Abdominal Approach Surgical Training,” U.S. Provisional Patent Application No. 62/630,442, filed February 14, 2018. Erinn M. Myers has received an unrestricted educational grant from Boston Scientific to fund fellow cadaver laboratory (no money from this grant was used for the purposes of model development or study). She also received money paid to her from Teleflex and Laborie. Brittany L. Anderson-Montoya's institution received money paid to her from CHS Research Innovation. In addition, money was paid to her from Mission Health for a speaking engagement. Smitha Vilasagar received money paid to her from Teleflex.

Presented at the American Urogynecologic Society's 39th Scientific Meeting, October 9–13, 2018, Chicago, Illinois; and at the American Association of Gynecologic Laparoscopists' 43rd Scientific Meeting, November 11–15, 2018, Las Vegas, Nevada.

The authors thank the Carolinas Simulation Center for the material support and teammate time and the American Urogynecologic Society for allowing us to assess the hierarchical task analysis at the 2018 AUGS meeting in Chicago, IL.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.