Thesis (Ph.D)-Cairo University, 2023.

Bibliography: pages 88-111.

Background and rationale:
Diagnostic or operative hysteroscopy is one of the most common
surgical intervention in gynecological surgery. In recent years, it has acquired
a central role in diagnosis and treatment of a variety of uterine pathologies
like fibroids, polyps and uterine malformations (Gambadauro et al., 2014;
Di SpiezioSardo et al., 2008 and Capmas et al., 2016). It is also pivotal in
the management of primary or secondary infertility (Lorusso et al., 2008).
Biopsy specimens are also sampled with hysteroscopy in the diagnosis of
endometrial cancer (Clark et al., 2002).
In recent years, the technological advancements such as the use of small
diameter (3,5mm) rigid hysteroscopes combined with “no touch” techniques
have made hysteroscopy a commonly accepted procedure (Bettocchi et al.,
2003 and Mairos and Martino, 2016).
As a minimally invasive procedure, hysteroscopy is associated with
fewer complications than traditional open surgery (Elessawy et al., 2017).
However, it is challenging to gain manual dexterity in hysteroscopy because
of the fulcrum effect and the orientation between the two-dimensional screen
and the three-dimensional uterine cavity. Other difficulties are the diminished
tactile feedback and limited degrees of freedom (Korndorffer et al., 2005).
Lack of proficiency in hysteroscopy can compromise patient safety by causing
uterine perforation and trauma to neighboring organs. Also, pulmonary air
embolisms and pulmonary edema are potential life-threatening complications
(McGurgan and McIlwaine, 2015).
Today it is generally accepted that the traditional apprentice-tutor
model is no longer valid for training all skills necessary in Gynecological
surgery and more specifically endoscopic surgery (Campo et al., 2016). This
agreement is based on the recognition that, in contrast to open surgery,
endoscopic surgery demands surgical skills and psychomotor skills that
should not necessarily be trained simultaneously. Increasing evidence strongly
suggests that psychomotor skills must be trained earlier and outside the
operating room, and several models have been proposed for this aim (Sroka
et al., 2010; Diesen et al., 2011; Munro, 2012; Mulla et al., 2012;
Escamirosa et al., 2015 and Hofstad et al., 2013).
Dawe et al., has shown that participants who reach proficiency in
simulation-based training performed with higher global assessment scores and
with fewer errors during patient-based encounters than their counterparts who
did not receive simulation training (Dawe et al., 2014).
Simulation-based training with virtual reality offers a great opportunity
to achieve the technical skills of hysteroscopy in a safe and controlled
learning environment prior to clinical practice on patients (Cook et al., 2011).
So, we aim in this study to evaluate the efficacy of VR hysteroscopy
simulation in improving hysteroscopic skills of residents and minimizing
surgical errors.
6. Objectives
The aim of this prospective comparative study is to evaluate the
efficacy of VR simulator training in improving basic gynecological
hysteroscopic skills and assess training levels in Ob/Gyn residents, as
compared to others with previous hysteroscopic experience.

ﯾﺟـــب ﻋﻠـــﻲ اﻷطـــﺎء ﻓـــﻲ اﻟـــﺳﻧوات اﻷﺧﯾـــرة اﻟﺣﻔـــﺎ ﻋﻠـــﻰ ﻔـــﺎءة اﻟﻣﻬـــﺎ ارت طـــوال ﺣـــﺎﺗﻬم
اﻟﻣﻬﻧ"ﺔ ﻋن طر&ã اﻟﺗدر&ب اﻟﻌﻣﻠﻲ اﻟﺟارﺣﻲ. ﻟﻘد أﺻﺢ اﻟﺗدريب اﻟﻌﻣﻠﻲ اﻟﺟارﺣﻲ ﻟﻠﻣﺗدر+ﯾن ﺧـﺎرج
ﻏرف اﻟﻌﻣﻠ"ﺎت ﺣﯾث ﻓﺻول اﻟﺗدر&ب وﻏرف اﻟﻣﺣﺎﻛﺎة.
ــﺎن اﻟﻐــرض ﻣــن ﻫــذﻩ اﻟد ارﺳــﺔ ﻫــو اﻟﺗﺄﻛــد ﻣــن دور اﻟواﻗــﻊ اﻻﻓﺗ ارﺿــﻲ ﻓــﻲ اﻟﺗــدر&ب ﻋﻠــﻰ
اﺳﺗﺋﺻﺎل اﻟﺳﻠﯾﻠﺔ ﺎﻟﻣﻧظـﺎر اﻟرﺣﻣـﻲ ﻣـن ﺧـﻼل ﺗـدر&ب اﻟﻣﺑﺗـدﺋﯾن ﺛـم ﻣﻘﺎرﻧـﺔ ﻧﺗـﺎﺋﺟﻬم ﻣـﻊ ﺗﻠـك اﻟﺗـﻲ
ﺣﻘﻘﻬﺎ اﻟﺧﺑ ارء ﺎﺳﺗﺧدام ﺟﻬﺎز ﻣﺣﺎﻛﺎة ﻣﻧظﺎر اﻟرﺣم ﺎﻟواﻗﻊ اﻻﻓﺗ ارﺿﻲ.
أﺟر&ت ﻫذﻩ اﻟد ارﺳﺔ ﻓﻲ ﻣﺧﺗﺑر ﻣﺣﺎﻛﺎة اﻟﻣﻧظﺎر ﺎﻟواﻗﻊ اﻻﻓﺗ ارﺿﻲ واﻛﺗﺳﺎب اﻟﻣﻬﺎ ارت ﻓﻲ
ﻗﺻر اﻟﻌﯾﻧﻲ، ﻗﺳم أﻣ ارض اﻟﻧﺳﺎء واﻟﺗوﻟﯾد، ﺟﺎﻣﻌﺔ اﻟﻘـﺎﻫرة ﻌـد ﻣواﻓﻘـﺔ ﻟﺟﻧـﺔ أﺧﻼﻗ"ـﺎت اﻟ ﺣـث ﻣـن
ﻣﺎﯾو ١٢٠٢ إﻟﻰ أﺑر&ﻞ ٢٢٠٢.
ﺷﺎرك ٢٠١ طﺑﯾً ﺎ وﺗم ﺗﻘﺳ ﻣﻬم إﻟﻰ ﻣﺟﻣوﻋﺗﯾن:
اﻟﻣﺟﻣوﻋــﺔ أ: ﺿــﻣت ١٥ طﺑﯾ ــﺎً أﺟــروا أﻗــﻞ ﻣــن ٠٥ ﻣﻧظــﺎر رﺣﻣــﻲ ﺗﺷﺧ"ــﺻﻲ واﺳﺗﺋــﺻﺎل ﺳــﻠﯾﻠﺔ
اﻟــرﺣم ﺎﻟﻣﻧظــﺎر ﻣــﻧﻬم اﻷط ــﺎء اﻟﻣﻘ"ﻣــﯾن وﻣــﺳﺎﻋدO اﻟﻣﺣﺎﺿــر&ن واﻟﻣﺣﺎﺿــر&ن واﻷﺳــﺎﺗذة
اﻟﻣﺳﺎﻋدﯾن ﻓﻲ ﻣﺳﺗﺷﻔﻰ اﻟﻘﺻر اﻟﻌﯾﻧﻲ (ﻣﺑﺗدﺋﯾن).
اﻟﻣﺟﻣوﻋـﺔ ب: ﺿـﻣت ١٥ طﺑﯾ ـﺎً أﺟـروا ﻣـﺎ ﻻ "ﻘــﻞ ﻋـن ٠٥ ﻣﻧظـﺎر رﺣﻣـﻲ ﺗﺷﺧ"ـﺻﻲ واﺳﺗﺋــﺻﺎل
ﺳــﻠﯾﻠﺔ اﻟــرﺣم ﺎﻟﻣﻧظــﺎر ﻣــﻧﻬم ﻣﺣﺎﺿــر&ن وأﺳــﺎﺗذة ﻣــﺷﺎر ﯾن وأﺳــﺎﺗذة ﻓــﻲ ﻣﺳﺗــﺷﻔﻰ اﻟﻘــﺻر
اﻟﻌﯾﻧﻲ و ازﺋر&ن ﻓﻲ اﻟوﺣدات اﻟﻣﺗﺧﺻﺻﺔ ﻣﺳﺗﺷﻔﻰ اﻟﻘﺻر اﻟﻌﯾﻧﻲ (ﺧﺑ ارء).
ﺗﻠﻘـــﻰ اﻷط ـــﺎء ﻓـــﻲ اﻟﻣﺟﻣوﻋـــﻪ أ دورة ﺗدر&ﺑ"ـــﺔ ﺎﺳـــﺗﺧدام طر&ﻘـــﺔ اﻟﺗـــدر&ب واﻻﺧﺗ ـــﺎر ﻋﻠـــﻰ
VirtaMed وﻣﺣﺎﻛـــﺎة اﻟواﻗـــﻊ اﻻﻓﺗ ارﺿـــﻲ ﻟﺗﻧظﯾـــر اﻟـــرﺣم (HYSTT) ﻣﻬـــﺎ ارت ﺗﻧظﯾـــر اﻟـــرﺣم
™ GynoS ﺗم ﺗﻘﯾ"م ﺟﻣ"ﻊ اﻷط ﺎء ﻋﻠﻰ اﻟﺗﻧﻘﻞ ﺎﻟﻛﺎﻣﯾ ار ﻓﻲ وﻗت ﻣﺣدد وا ازﻟﺔ اﻟﻣـﺳﺎﻣﯾر ﻋﻠـﻰ ﻧﻣـوذج
HYSTT. ﺗ ـــﻊ ذﻟـــك ﺗﻘﯾــــ"ﻣﻬم ﺎﺳـــﺗﺧدام اﺧﺗ ـــﺎر&ن ﻓــــﻲ ﺟﻬـــﺎز اﻟﻣﺣﺎﻛـــﺎة VirtaMed "اﻟﺗــــﺷﺧ"ص
اﻟــﺳﻬﻞ ٣" و"ﻣﻘــص اﺳﺗﺋــﺻﺎل اﻟزواﺋــد اﻟﻠﺣﻣ"ــﺔ" ﻌــد ﻣــﺷﺎﻫدة اﻟﻌــرض اﻟﺗوﺿــ"ﺣﻲ ﻟﻛــﻞ اﺧﺗ ــﺎر. ﺗــم
ﺟﻣﻊ ﻧﺗﺎﺋﺞ اﻷط ﺎء ﻓﻲ ﻼ اﻟﻣﺟﻣوﻋﺗﯾن واﺧﺿﺎﻋﻬم ﻟﻠﺗﺣﻠﯾﻞ اﻹﺣﺻﺎﺋﻲ. ﻓﻲ ﻫذﻩ اﻟد ارﺳﺔ، ﺎن ﻫﻧﺎك ﻓـرق ذو دﻻﻟـﺔ إﺣـﺻﺎﺋ"ﺔ ﺑـﯾن اﻟﻣﺟﻣـوﻋﺗﯾن ﻓ"ﻣـﺎ ﯾﺗﻌﻠـã ﻌﻣـر
اﻷط ـــﺎء وﻣــــدة اﻟﻣﻣﺎرﺳــــﺔ ﻣـــﻊ ﻗ"ﻣــــﺔ ٠.١٠٠>P. ﻓ"ﻣــــﺎ ﯾﺗﻌﻠـــã ــــﺎﻟﻧوع، ــــﺎن ﻫﻧـــﺎك ٧٢ أﻧﺛــــﻰ ﻓــــﻲ
اﻟﻣﺟﻣوﻋﺔ (أ) (٢٥.٩٪) و٨١ أﻧﺛﻰ ﻓﻘ& ﻓﻲ اﻟﻣﺟﻣوﻋﺔ (ب) (٥٣.٣٪) وﻟﻛن ﺎن اﻟﻔـﺎرق ﺿـﺋ" ًﻼ
.P إﺣﺻﺎﺋً"ﺎ ﻘ"ﻣﺔ ٠.٥٥٠
ãأظﻬـرت اﻟﻧﺗــﺎﺋﺞ أﻧـﻪ ﻟــم " ـن ﻫﻧــﺎك ﻓـرق ذو دﻻﻟــﺔ إﺣـﺻﺎﺋ"ﺔ ﺑــﯾن اﻟﻣﺟﻣـوﻋﺗﯾن ﻓ"ﻣــﺎ ﯾﺗﻌﻠــ
ﺎﻟﺗﻧﻘـــﻞ ﺎﻟﻛـــﺎﻣﯾ ار ﺑوﻗـــت ﻣﺣـــدد وا ازﻟـــﺔ اﻟﻣـــﺳﺎﻣﯾر ﺎﺳـــﺗﺧدام ﻧﻣـــﺎذج HYSTT. ـــﺎن ﻣﺗوﺳـــ& وﻗـــت
اﻟﺗﻧﻘﻞ ﻓﻲ اﻟﻣﺟﻣوﻋﺔ أ ٠.٤٤±١.٤٩ دﻗ"ﻘـﺔ ﻣﻘﺎﺑـﻞ ٢.٣١±٠.٥٣ دﻗ"ﻘـﺔ ﻓـﻲ اﻟﻣﺟﻣوﻋـﺔ ب ﻘ"ﻣـﺔ
P٠.١١. ـــــــﺎن ﻣﺗوﺳـــــــ& اﻟوﻗـــــــت ﻹ ازﻟـــــــﺔ اﻟﻣـــــــﺳﺎﻣﯾر ﻓـــــــﻲ اﻟﻣﺟﻣوﻋـــــــﺔ أ وب ٠.٣±٣.٥٢ دﻗ"ﻘـــــــﺔ
.P و٣.٤٢±٠.١٣ دﻗ"ﻘﺔ ﻋﻠﻰ اﻟﺗواﻟﻲ ﻣﻊ ﻗ"ﻣﺔ ٠.٨٦
ﻓــﻲ د ارﺳــﺗﻧﺎ، ﻟــم " ــن ﻫﻧــﺎك ﻓــرق ذو دﻻﻟــﺔ إﺣــﺻﺎﺋ"ﺔ ﺑــﯾن اﻟﻣﺟﻣــوﻋﺗﯾن ﻓ"ﻣــﺎ ﯾﺗﻌﻠــã ﺑﻧــﺳ ﺔ
ﺗﺟو&ﻒ اﻟرﺣم اﻟﻣرﺋﻲ وﻣﺣـﺎذاة اﻟﻛـﺎﻣﯾ ار و وﻗـت اﻟرؤ"ـﺔ اﻟﻣـﺷوﺷﺔ وﺗـﺻو&ر اﻟﻔـوﻫﺗﯾن وطـول اﻟﻣـﺳﺎر
اﻟﺗ ارﻛﻣـــﻲ وﺗﻼﻣـــس اﻟﻣﻧظـــﺎر ﻣـــﻊ ﻋﻧـــã اﻟـــرﺣم وﺗﺟو&ـــﻒ اﻟـــرﺣم ﻓـــﻲ اﺧﺗ ـــﺎر اﻟﺗـــﺷﺧ"ص واﺳﺗﺋـــﺻﺎل
اﻟزواﺋد اﻟﻠﺣﻣ"ﺔ.
ﻓــﻲ اﻟد ارﺳــﺔ اﻟﺣﺎﻟ"ــﺔ ــﺎن ﻫﻧــﺎك ﻓــرق ذو دﻻﻟــﺔ أﺣــﺻﺎﺋ"ﺔ ﺑــﯾن اﻟﻣﺟﻣــوﻋﺗﯾن ﻓــﻲ اﻻﺧﺗ ــﺎر
اﻟﺗﺷﺧ"ــﺻﻲ ﻓ"ﻣــﺎ ﯾﺗﻌﻠــã ﺎﻟــدرﺟﺎت اﻹﺟﻣﺎﻟ"ــﺔ و درﺟــﺔ ﺗــﺻو&ر اﻟــرﺣم و درﺟــﺔ اﻟــﺳﻼﻣﺔ واﺳــﺗﻌﻣﺎل
اﻟﺳواﺋﻞ و اﻟﺗوﻗﯾت اﻟذO ﺎن ﻓ"ـﻪ اﻟـرﺣم ﻏﯾـر ﻣﻧـﺗﻔﺦ ﻟـﺻﺎﻟﺢ اﻟﻣﺟﻣوﻋـﺔ (أ). ﻣـﺎ ـﺎن ﻫﻧـﺎك ﻓـرق
ﻣﻌﺗــد ــﻪ إﺣــﺻﺎﺋً"ﺎ ﺑــﯾن اﻟﻣﺟﻣــوﻋﺗﯾن ﻓ"ﻣــﺎ ﯾﺗﻌﻠــã ﺎﻻﻗﺗــﺻﺎد ﻓــﻲ اﺧﺗ ــﺎر اﺳﺗﺋــﺻﺎل اﻟــﺳﻠﯾﻠﺔ وﺗوﻗﯾــت
اﺳﺗﺋـــــــــــﺻﺎﻟﻬﺎ ﻟـــــــــــﺻﺎﻟﺢ اﻟﻣﺟﻣوﻋـــــــــــﺔ (أ). ـــــــــــﺎن ﻣﺗوﺳـــــــــــ& وﻗـــــــــــت اﻹﺟـــــــــــ ارء ﻓـــــــــــﻲ اﻟﻣﺟﻣوﻋـــــــــــﺔ أ
.P وب٠.٥٤٦±٢.٦٤٥ دﻗ"ﻘﺔ و٣.٢٣١±١.٦١ دﻗ"ﻘﺔ ﻋﻠﻰ اﻟﺗواﻟﻲ ﻣﻊ ﻗ"ﻣﺔ ٠.٢٠٠

Issues also as CD.

Text in English and abstract in Arabic & English.