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Implementation and Validation of a Retroperitoneal Dissection Curriculum
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Implementation & Validation of a Laparoscopic Retroperitoneal Dissection Curriculum

Aisha A. Yousuf1,2, MD FACOG, Helena Frecker1,3, MD FRCSC, Abheha Satkunaratnam1,2, MD FRCSC, Eliane M. Shore1,2, MD MSc FRCSC

1Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, 2Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON,

3Department of Obstetrics and Gynecology, Michael Garron Hospital, Toronto, ON.


• Competency-based education requires educators to use simulation

training to increase residents’ exposure to various procedures.1,2

• Technical training in a simulated environment leads to improved

operating room performance and better patient outcomes.3

• Integrating simulation models into formal and comprehensive

curricula increases surgical competency.4

• The American College of Obstetricians and Gynecologists has

initiated “ACOG Simulations Working Group” to develop and

implement standardized and validated simulation-based curricula.5

• Validated simulation is lacking in gynecologic laparoscopy training.6

• No Surgical Curricula or Simulation Models exist for Laparoscopic

Retroperitoneal Dissection to Identify the Ureter.


• A comprehensive curriculum to teach LRD was designed

encompassing didactic and technical skill components using a

previously developed pelvic model.

• Novice gynecologic surgeons (<10 previous LRD) were recruited.

• Participants underwent pre- and post- curriculum multiple-choice

questions (MCQ) to evaluate knowledge.

• Pre- and post-curriculum performance on model was videorecorded.

• Subjects were then video-recorded performing LRD in the

operating room within 3 months of the curriculum.

• All videos were blindly assessed by an expert using the objective

structured assessment of technical skills tool (OSATS).7


• To design a comprehensive curriculum for laparoscopic

retroperitoneal dissection (LRD) using our previously developed

simulation model.

• To implement the curriculum with OBGYN trainees.

• To evaluate the curriculum’s impact on surgical skills and

knowledge of ureteric anatomy and potential complications.


Figure 1A. Didactic Curriculum: PowerPoint lecture involving an

educational video on laparoscopic ureterolysis using operating room


Figure 1B. Technical Curriculum: One-on-one instruction using the

simulation model.

Figure 2. Study Flow Diagram

Table 1. Demographic Information (n=30)

Figure 3A. MCQ Knowledge Scores (n=29).

Figure 3B. Model OSATS Scores (n=30).

A positive statistically significant correlation exist between

Intraoperative OSATS scores & the post-curriculum Model

OSATS scores ( r = .46 , p = 0.03 ).



• A comprehensive retroperitoneal dissection curriculum

showed objective improvement in knowledge and

technical skills.

• Improvement in the simulation laboratory also translated

to competent performance in the operating room.

• Residents subjectively noted an improvement in skills

acquisition following curriculum completion.



1. Sanders, A. et al. Simulation Training in Obstetrics and Gynaecology Residency Programs in

Canada. Journal of Obstetrics and Gynaecology Canada 37, 1025-1032, (2015).

2. Caccia, N. et al. Competency-Based Medical Education: The Wave of the Future. Journal of

Obstetrics and Gynaecology Canada 37, 349-353, (2015).

3. Aggarwal, R. et al. An evidence-based virtual reality training program for novice laparoscopic

surgeons. Annals of surgery 244, 310-314, (2006).

4. Shore, E. M. et al. Gynecology resident laparoscopy training: present and future. Am J Obstet

Gynecol 212, 298-301, 298 e291, (2015).

5. Simulations Working Group- American College of Obstetrician and Gynecologists.

http://www.acog.org/About-ACOG/ACOG-Departments/Simulations-Consortium. Web.21 Apr.2017.

6. Burden, C. et al. Integration of laparoscopic virtual-reality simulation into gynaecology training.

BJOG: An International Journal of Obstetrics & Gynaecology 118, 5-10, (2011)

7. Martin, J. A. et al. Objective structured assessment of technical skill (OSATS) for surgical

residents. Br J Surg 84, 273-278 (1997).

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