Development of a Realistic Physical Phantom for Laparoscopic and Robotic-Assisted Sacrocolpopexy Training and Associated

Abstract

Objective: Robotic-assisted sacrocolpopexy is the gold standard for treating advanced pelvic organ prolapse, but its most critical step, presacral dissection, carries a significant risk of vascular and ureteral injury. Traditional training relies heavily on intraoperative exposure, yet no simulator currently provides an anatomically realistic, reusable, and cost-effective platform for practicing this high-risk procedure. Method: To address this gap, we developed a modular phantom designed for training in laparoscopic and robotic sacrocolpopexy procedures. A hierarchical task analysis was conducted to identify the critical steps involved in presacral dissection, informing the design of the simulator. The phantom incorporates a reusable pelvic base and a stratified sacral area pad that reproduces the vertebrae, anterior longitudinal ligament, vascular structures, ureters, visceral fat, and peritoneum. Fabrication employed 3D printing, silicone molding, and layered composite materials to strike a balance between anatomical fidelity and durability. Results: Five expert gynecologic surgeons validated the simulator using structured questionnaires, hierarchical task analysis-based task assessment. The model demonstrated excellent content validity (S-CVI = 0.877), strong inter-rater agreement, and high internal consistency (Cronbach's alpha = 0.925). Ten of thirteen critical surgical tasks were completed by all participants, including realistic dissection and ligament exposure. Face validity ratings confirmed the realism of anatomy and haptic feedback, though ureteral identification was less consistent. Conclusion: The developed phantom enables realistic, structured training in presacral dissection and mesh fixation, supporting skill acquisition outside the operating room. Clinical Impact - By providing a cost-effective, reusable, and anatomically faithful simulator, this work contributes to safer training in gynecology and pelvic floor surgery, with potential integration into competency-based curricula and dry-lab facilities.