Simulating Vascular Emergencies in Robotic Surgery: Preparing OB-GYN Residents for Surgical Complications

Objective: To teach and prepare obstetrics and gynecology (OB-GYN) trainees for rare, vascular emergencies that can occur during robotic surgery before they encounter such a stressful intraoperative event. We sought to create, evaluate, and implement two inexpensive vascular bleeding models for robotic gynecologic surgery simulation. Design: Using readily available materials such as plastic tubing, twisting balloons, foam, a suction container, and a small water pump, we created two vascular bleeding models. A small diameter vessel was made with 2- and 3-mm tubing and secured to a foam uterus. A larger diameter vessel using twisting balloons was then secured to a board. The models were connected to a small water pump that simulated blood flow. The tubing was punctured, and the models were placed in the training abdomen and robot docked. Trainees then worked through patient cases to control the bleed robotically. Setting: The simulated operating room at the University of Nebraska Medical Center Davis Global Center. Participants: Sixteen OB-GYN residents, house officer 1-4 participated in a robotic surgery simulation. Results: The low-cost bleeding models effectively simulated vascular emergencies during robotic surgery. OB-GYN residents participated in two robotic gynecologic surgery simulated cases, first encountering a small diameter vessel bleed and then a larger diameter vessel bleed. With guidance from faculty, the residents successfully identified and managed both bleeding emergencies. The residents provided positive verbal feedback on the realism and effectiveness of the models. Conclusions: The low-cost bleeding models successfully simulated vascular emergencies during robotic surgery, providing OB-GYN residents with valuable experience in managing such scenarios, which can be very stressful when encountered. Future goals for our models include improving anatomical realism, testing efficacy, and expanding use to multidisciplinary surgical teams. By doing so, we aim to reduce surgical complications, enhance patient outcomes, and contribute to the advancement of surgical training.