Development of a Personalized and Simplified Ovarian Cystectomy Practice Tool

OBJECTIVE Ovarian cystectomy requires a gentle approach to help preserve the postoperative ovarian function.[1-7] However, limited resources and infrastructure are available for surgical training and off-the-job training methods. We designed a tool to enable safe and effective practice of ovarian cystectomies. The preparation and use of this personalized and simplified ovarian cystectomy practice tool are demonstrated through a stepwise video demonstration [Video]. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_3uh4z75i"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} DESIGN A video demonstrating the stepwise approach for assembling a tool that may be used for providing surgical training. The study was exempted from ethical approval requirements because it did not involve human or animal experimentation. SETTINGS The key components of the set-up include water balloons and an elastomer prepared by the Japanese manufacturer Tenga Co., Ltd.[8] Currently, six types of elastomers are available.[9] The wave line (blue) type is the most suitable, owing to its strong adhesion to the balloon, making it the most challenging and therefore, more representative of the actual clinical situation. INTERVENTIONS Trainees can practice using this setup by separating the “balloon that mimics a cyst” from the “TENGA Pocket that mimics the normal ovarian tissue.” The TENGA Pocket and balloon moderately adhere to each other, and the balloon can readily burst when manipulated roughly [Figure 1].Figure 1: (A) The TENGA Pocket and balloon moderately adhere to each other, and the balloon can burst easily when manipulated roughly, as shown in the figure on the right at the end of the arrow. The following items are required: (a) TENGA POCKET (TENGA Co., Tokyo, Japan), (b) long pin, (c) water balloon, and (d) balloon pump. The balloon pump can be filled with water. http://www.apagemit.com/page/video/show.aspx?num=320&kind=2&page=1The material used is reusable, unlike porcine material, and thus aids in reducing pollution. It meets the criteria for practice material and has the following advantages: Cost-effectiveness, i.e., the cost of reusable materials, except for consumables, may range between USD 8 and USD 9, with the cost of consumables alone being approximately USD 3 Easy and quick to assemble (preparation time is only 2–3 min) Replicates the actual clinical conditions Appropriate degree of difficulty (the balloon can rupture readily if handled inappropriately) Surgical practice closely simulates real surgical procedures (because the material is in contact with the target organ). CONCLUSION Historically, researchers have developed several methods to practice laparoscopic surgery. A previous study has described practice models using pigs to mimic bladder tumors,[10] while another has reported an ovarian cyst removal model using yoghurt and balloons.[11] However, both reported methods require considerable effort to create and may be difficult to adapt for personal use. To the best of our knowledge, none of these methods were tailored specifically for the delicate execution of ovarian cystectomies. The practice tool we have designed has valuable advantages, including ease of use and affordability. TENGA is available globally and easily accessible for purchase. In addition, its ease of creation and reproducibility is significant for laparoscopic surgeons. Author contributions Conceptualization, H.K. and K.C.; Methodology, H.K.; Investigation, H.K. and A.M ; Resources, H.K. A.M ; Data Curation, H.K.; Writing H.K and K.C ; Supervision, I.K. All authors have read and agreed to the final version of the manuscript. Data availability statement All data generated or analyzed during this study are included in this published article. Financial support and sponsorship Nil. Conflicts of interest Kenro Chikazawa received honoraria from Ethicon (Tokyo, Japan), Terumo (Tokyo, Japan), Chugai Pharmaceutical Co. (Tokyo, Japan), and Kaken Pharmaceutical Co. (Tokyo, Japan).