Construct Validity of a Laparoscopic Uterosacral Ligament Suspension Simulator

Objectives: The Laparoscopic Uterosacral Ligament Suspension (LUSLS) procedure is an effective treatment for apical prolapse. Urogynecology and Reconstructive Pelvic surgeons (URPS) traditionally teach this technique through the Halstedian training model in the operating room. LUSLS is a simple and effective technique that could be expanded to laparoscopic surgeons for addressing prolapse during concomitant procedures. To address the increasing demand for a simulation model for the LUSLS procedure, we developed a low-cost simulation model. This study assessed construct and face validity of the LUSLS simulation model we developed.

Methods: Our research team secured a booth at the American Urogynecologic Society Pelvic Floor Disorder Conference in Portland, OR from October 4-6, 2023. Anonymous volunteer participants verbally consented to the study. Participants were video recorded performing the LUSLS procedure on the simulated model, and only the laparoscopic instruments were visible in the recording. Participants then completed a survey that included demographic information and their perceptions of the model. This study was categorized as a Quality Initiative (QI) project and was exempt from Institutional Review Board approval. Eligible participants at the conference included gynecology residents, URPS fellows, and URPS attending physicians. Non-physician medical providers who do not perform the procedure were excluded. Video recordings were evaluated by two fellowship-trained URPS attendings using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) assessment, which included a 5-item global rating scale assessing depth perception, dexterity, efficiency, tissue handling, and autonomy.

Results: Out of 31 participants, 22% were classified as novice (PGY1-3). Nearly all (94%) agreed the simulator facilitated LUSLS skills. Participants rated the simulator a median of 7/10 for accurately reflecting necessary skills and 8/10 for perceived value of incorporating the simulation into their educational content. Of the 8 participant videos independently assessed by URPS faculty, experienced surgeons scored a median of 17 and novice surgeons a median of 10 on the GOALS assessment. A negative correlation between task time and GOALS score was observed (-0.642 Spearman correlation coefficient). See Figure 1.

Conclusions: Early results of this pilot project suggest construct and face validity of a low-cost LUSLS simulation model. If further validated, this model has the potential to enhance trainee education and increase the scope of practice for non-URPS surgeons trained in laparoscopic gynecology.

Preliminary findings indicate a non-statistically significant trend towards higher GOALS assessment scores and gynecologic training level, constrained by low power. There's a strong negative correlation between simulation completion time and competence score. Most participants express the value of this simulator for their training. These early results underscore the benefits of affordable simulation models in the training of resident and non-Urogynecology and Reconstructive Pelvic surgeons.