Development and validation of a cost-effective DIY simulation model for McDonald cerclage training

Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-024-07812-8 MATERNAL-FETAL MEDICINE Development and validation of a cost‑effective DIY simulation model for McDonald cerclage training Johanna Buechel1,2 · Adam Kalisz3 · Saskia‑Laureen Herbert4 · Anne Scherer‑Quenzer4 · Bettina Blau‑Schneider4 · Teresa Starrach5 · Katrina Kraft6 · Achim Wöckel4 · Ulrich Pecks2,4 · Matthias Kiesel4 Received: 10 September 2024 / Accepted: 23 October 2024 © The Author(s) 2024 Abstract Purpose The prevention of preterm birth is a challenging task for obstetricians. Cervical cerclage, used as both a primary and secondary prevention method for spontaneous preterm birth, is a crucial surgical intervention. It is essential that obstetricians can learn this procedure in a simulated environment before performing the stitches on high-risk patients. This study aimed to develop a simulator based on 3D printing and evaluate its validity for clinical training. Methods The objectives of this study were (1) to design and construct a cost-effective simulator for McDonald cerclage with two different cervix models—a closed cervix and a cervix with bulging membranes—using common material from a DIY store and 3D printing technology and (2) to validate its effectiveness through feedback from learners and experts in cervical cerclage. The self-made simulator was evaluated by obstetricians using a questionnaire with Likert scale. Results Obstetricians and gynecologists assessed the simulator and found it useful for learning and practicing cervical cerclage. The simulator was deemed valuable for skill training. Conclusion Cervical cerclage is a complex procedure that should be mastered through simulation rather than initial practice on real patients. Our simulator is a cost-effective model suitable for various clinical settings. It has been validated by obstetricians for both preventive and therapeutic cerclage, demonstrating its efficacy for training in cerclage techniques. Future research should focus on less skilled obstetricians and gynecologists and investigate how repeated use of the simulator can enhance their performance in cerclage stitching. Keywords Surgical training · Cervical stitch · Preterm birth · Skills training · High-risk pregnancy What does this study add to the clinical work * Johanna Buechel 1 Department of Obstetrics and Gynecology, University Hospital Würzburg, Josef‑Schneider‑Str. 4, 97080 Würzburg, Germany 2 Maternal Health and Midwifery, Julius-Maximilians-Universi ty, Würzburg, Germany 3 Department of Electrical, Electronic and Communication Engineering, Information Technology (LIKE), Friedrich-Ale xander-Universität Erlangen-Nürnberg, Erlangen, Germany 4 Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany 5 Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany 6 University Clinic of Gynecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany The McDonald cerclage simulator is an excellent way to practice McDonald cerclage stitching in a safe setting. Our model provides a cost-effective option that still closely approximates real-life conditions. Introduction Preterm birth is a global health problem affecting 6–12% of all babies and preventing it remains a significant challenge in perinatal medicine [1]. Premature birth contributes significantly to perinatal morbidity and mortality. Within various causes, spontaneous preterm birth accounts for 70% of preterm deliveries [2]. Cervical cerclage is an established technique for preventing preterm birth: a Vol.:(0123456789) Archives of Gynecology and Obstetrics Cochrane review with 15 studies showed a reduction of premature birth but a non-significant reduction of perinatal mortality [3]. It can be used prophylactically for pregnant women with a history of preterm birth or mid-trimester miscarriage, for those with a shortened cervix as detected by sonography, or as a “rescue method” and secondary prevention when the cervix is already open with bulging membranes [4–6]. The most used techniques are the Shirodkar and the McDonald cerclage with no clear advantage for one technique [7, 8]. The McDonald technique is a purse-string suture around the cervix whereas the Shirodkar technique involves colpotomy and bladder dissection to gain a higher suture placement [9]. The surgical procedure for inserting a cerclage needs training and training occasions are sometimes difficult, as suitable patients often come to the hospital unpredictably and the procedure is not performed electively. Even in hospitals with a large number of high-risk pregnancies, the rate of patients requiring a cervical cerclage is low, so the procedure is rarely performed. Moreover, there is a considerable risk of complications such as premature rupture of membranes, bleeding, infections, and induction of labor which can subsequently lead to pregnancy loss. As the procedure affects both the mother and the unborn child, it can be considered a very stressful situation, and therefore, belongs in experienced hands. Therefore, the simulation models for cerclage placement are highly valuable for perinatal units to train their staff. In surgical specialties, simulation is widely used for various procedures, such as laparoscopic training [10]. In obstetrics, there are examples like simulation models for training in cesarean section with impacted fetal head [11], vaginal-operative birth [12] or shoulder dystocia [13]. Vaginal surgery, with its challenging access, seems ideal for simulation training [14]. In this study, we describe the design process and construction of a McDonald cerclage trainer based on 3D-printed cervical models and evaluate its suitability for training purposes as assessed by skilled experts and advanced learners in the field. Materials and methods This study includes the development of the simulator and its validation by cerclage experts and trainees. A certificate of non-objection was obtained from the Ethics Committee of the University Hospital Wuerzburg (application number 2024030502). Simulator design and development The Wuerzburg Cervical Cerclage Simulator (WCCS) was developed by two obstetricians and a computer scientist using common materials from a Do it yourself (DIY) store and cervix models. The production of the latter based on 3D printing and molding silicone. A drainpipe (Marley Deutschland GmbH, Wunstorf, Germany) with a 10 cm diameter was used to simulate the vagina, with foamed plastic (isopur, softpur GmbH, Goellheim, Germany) mimicking the vaginal walls. The drainpipe was mounted on a base plate with the size of 40 × 30 cm (Wibo Kunststofftechnik GmbH, Meitingen) utilizing screws and super glue. The base plate could be angled relative to a second base plate to which it was combined with screws. Suction cups were used to secure the model on a desktop, and two bar clamps could be used additionally to fi (...truncated)