Conceptualization and Prototyping of a Modular Female Genital Surgery Model for Schema-Based Resident Education

Goals/Purpose: Demand for female genital surgeries continue to rapidly increase, including labiaplasty, clitoral hood reduction, hymenoplasty, perineoplasty, labia majora augmentation, and vaginoplasty. Labiaplasties increased by 237% between the years 2012 to 2020.¹ However, resident education has been nominal due to limited exposure, a highly sensitive nature of the procedure, and varying techniques.² Therefore, the purpose of this study is to create the first modular female genital surgery model for schema-based resident education (Fig 1A). The model features disposable, interchangeable components representing different phenotypes. Varying combinations of the components allow for a diverse range of anatomies. Dispensable components will allow residents to practice core principles including local anesthesia and blocks, surgical and flap planning, handling of delicate tissue, practice suturing in a constricted field, and minimization of adverse outcomes (nerve injury, fistula formation, hematoma). We hypothesize that this unique combination of affordability, diverse representation of anatomies, and dimensionality will provide higher-quality and effective training, with reduced cognitive load for novices.

Methods/Technique: The model was partitioned into interchangeable anatomic components (Fig 1B), with variables and common phenotypes of each anatomic component identified. The anatomic components were easily interchangeable to allow for exponential combinations of anatomies. Initial designs were based off the literature reported values, open-sourced patient imaging files (ie MRI) and photographs³, and a volunteer nulliparous and premenopausal model to identify anatomically accurate dimensions. Feedback and edits were solicited from co-investigators for iteractive design and prototyping. We used mixed design methodologies of molding with modeling clay and sculptor’s wax, 3D scanning, and computer aided modeling and design (Solidworks® v30, Dassault Systemes, Velizy-Villacoublay, France). Models were produced via additive manufacturing with 3D printing fused deposition modeling with dual extrusion (Airwolf3D EvoR, Airwolf 3D, Las Vegas, NV) and modeling clay.

Results/Complications: We successfully prototyped a female genital surgery model with individual components that can be “clipped in” to represent different anatomies. We demonstrated that the anatomy can be divided into components, allowing for interchangeable disposable parts and an exponential combination of anatomies. Production costs are estimated to be $10 in materials per full model set, and 2 hours per full model set, prior to optimization of production workflow and strategies for design for manufacturing.

Conclusion: This study is a proof-of-concept of the first modular female genital surgery model for resident education. The exponential combinations of component variations replicate diversity in phenotypes, and a progressive curriculum. Values of a modular, schema-based, hands-on trainer include breaking a complex procedure into smaller components, thus reducing cognitive load for novices, and tailoring training to individual trainees’ skill levels and adapting to progression.⁶ If successful, this approach of using modular 3D model for scenario-based skills acquisition can be applied to all procedures complicated by anatomic variation in different specialties. Next steps include prototyping of full component set with human tissue-like materials, development of a modular curriculum, and pilot studies with residents.

Figure 1.

(A) Each interchangeable component can be combined to result in an increasing diversity of anatomic models, and interval development of skills. For example, if there are 3 unique modules per component, then the combinations can result in 81 unique anatomic models. (B) We created four components to the model, with variables that can be modified per component. Note the modules can be easily interchanged manually while remaining stable for users using a locking mechanism. The minimalist and color-coded design further helps reduce cognitive overload for users. While certain featured components may not be visible to the trainee in practice (ie clitoris, bulb of vestibule), they serve as reminders to trainees of the delicate anatomy.