Innovation through the U.T.E.R.U.S: Utilization of a Three-D Model for Education and Research in Uterine Simulation
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2025
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Context: Learners often struggle to build confidence with intrauterine procedures like IUD insertion/removal and uterine aspiration. Current simulation models for developing these skills vary from costly high-fidelity models, low-cost low-fidelity models, or one-time use fruit models which lack realistic simulation of instrumentation of the cervix and uterus. Effective training assets for instruction of these procedures remain scarce. With increasing restrictions on abortion training, intrauterine procedure simulation may be especially important for learners in areas with limited abortion training access.
Objectives: This study aims to develop a low-cost, reusable, high-fidelity model using 3D printing technology for learners to practice intrauterine procedures.
Description of Innovation: The workflow to create the uterine model consists of Model Creation, Review, and Production. For Creation, an anonymized cadaver was MRI scanned, allowing for uterus identification and segmentation (Slicer), providing a mesh model that was subjected to artistic edits (Maya software). In Review, the model was uploaded to Sketchfab and Z-Space for visualization and final alterations. The final Production step comprised 3D printing using a Bambu X1C printer and Bambu Studio for support and infill settings.
The model dimensions are 87x177x32 mm using Polylactic Acid filament. 95A thermoplastic polyurethane (TPU) filament and colorFabb VarioShore TPU were attempted to produce more malleable models with variable shore hardness ratings. TPU reels are kept in a heated filament dryer for 12-24 hours before printing at a relative humanity (RH) of 15%, while ambient room RH is maintained at 50% RH. A 7% maze-like Hilbert curve infill was utilized for overhang support while reducing the rigidity of the printed model compared to the grid infill pattern. Volumetric print speed is also lowered, allowing better adhesion between layers. Additional design modifications may use multiple materials for different components.
Evaluation of Innovation: Complex Family Planning experts have reviewed and tested the initial models for anatomical accuracy, functionality, and durability using uterine dilators and uterine sounds. Experts provided feedback regarding elasticity, dimensions, shape, and additional components such as handle implementation for improved portability of the model. Current enhancements focus on developing a more anatomically realistic model with a uterocervical angle and increased flexibility. The model continues to undergo improvements/revision through an iterative process.
Upon development of a suitable model, learners and practicing clinicians will trial various iterations of procedural simulation, then complete a survey concerning ease of procedure, realism, and overall perception of the models. Survey responses will be analyzed using descriptive statistics. The resulting feedback will be used to revise and improve the model, and the cycle will repeat with multiple groups.
Discussion/Key Message: The workflow facilitates production of a lightweight, low-cost, and ease-of-use model with an inexpensive and widely available 3D printer. Immediate next steps include revisions using TPU filament for printing allowing for more malleability. Future work focuses on assessing the instructional effectiveness of the 3D-printed uterus, with learners evaluating/comparing simulation fruit, high-fidelity, and 3D-printed uterine models.
Target audience: Medical educators who teach intrauterine procedures and learners including medical students, residents, and fellows.
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