The Sexual and Reproductive Health and Rights (STARS) - Cervical Cancer Screening and Treatment module's Thermocoagulator Simulator allows nurses, midwives, clinical officers, and medical officers to become confident and competent in performing thermal ablation of cervical pre-cancer lesions as part of cervical cancer screening and treatment procedures performed in primary health care facilities and mobile units in resource-constrained settings. The Thermocoagulator Simulator is modelled on the Liger Medical HTU-110 Thermocoagulator™ and contains 5 componentsː (1) probe shaft with heating tip (including hot and cold probes of different probe tip diameters), (2) smartphone light to visualize the cervix, (3) mobile app-based user interface, (4) handle, and (5) augmented feedback circuit to alert the user if the heated probe touches the vaginal sidewalls of the Gynecologic Simulator.
This section explains how to construct the handle and "hot" and "cold" probe shafts with heating tips of the Thermocoagulator Simulator. The Liger Medical HTU-110 Thermocoagulator™ is designed with a probe shaft with heating tip that is inserted and removed unheated ("cold") which can reduce the risk of burn injury to the patient.[1] Other commercially available thermocoagulators are designed with probe shafts and heating tips that are inserted and removed while heated ("hot") which potentially increases the risk of thermal injury to the patient and practitioner. The Thermocoagulator Simulator is designed with removeable probes so the learner can practice thermal ablation with hot and cold probes.
Cut the cardboard in the shape as shown. The 5.0 cm length of the taller rectangle is the circumference for the 16.0 mm diameter probe tip.
2
Place Tape Perpendicular to Probe Tip (As Shown).
Attach Probe Tip to Shaft
Tape the thinner end of the cardboard strip firmly to the probe shaft.
3
Wrap Probe Tip Around Shaft While Taping Perpendicular (As Shown).
Secure Probe Tip to Shaft
Wrap the strip around the probe shaft while taping along the way.
Place tape perpendicular to the probe tip to secure it in place.
4
Cover the Taller Portion of the Cardboard Strip With Tape (As Shown).
Cover Probe Tip With Tape
Once the taller portion of the cardboard strip is reached, place and fold a long piece of tape over the top of the probe tip. IMPORTANT: This prevents the probe tip from sticking to the clay cervix model.
5
Line Up and Tape Together Edges of 5.0 cm Long Rectangle.
Line Up and Tape Edges of Rectangle
Line up and tape together the edges of the taller 5.0 cm long rectangle of the probe tip to create a circular probe tip with an outer diameter of 16.0 mm.
Continue wrapping and securing the probe tip to the probe shaft using tape.
6
Check That The Probe Tip's Outer Diameter Is 16.0 mm
Verify the 16 mm Diameter Probe Tip with a Ruler
Use a ruler to check that the probe tip's outer diameter is 16.0 mm.
Cut the cardboard in the shape as shown. The 6.0 cm length of the taller rectangle is the circumference for the 19.0 mm diameter probe tip.
2
Place Tape Perpendicular to Probe Tip (As Shown).
Attach Probe Tip to Shaft
Tape the thinner end of the cardboard strip firmly to the probe shaft.
3
Wrap Probe Tip Around Shaft While Taping Perpendicular (As Shown).
Secure Probe Tip to Shaft
Wrap the strip around the probe shaft while taping along the way.
Place tape perpendicular to the probe tip to secure it in place.
4
Cover the Taller Portion of the Cardboard Strip With Tape (As Shown).
Cover Probe Tip With Tape
Once the taller portion of the cardboard strip is reached, place and fold a long piece of tape over the top of the probe tip. IMPORTANT: This prevents the probe tip from sticking to the clay cervix model.
5
Line Up and Tape Together Edges of 6.0 cm Long Rectangle.
Line Up and Tape Edges of Rectangle
Line up and tape together the edges of the taller 6.0 cm long rectangle of the probe tip to create a circular probe tip with an outer diameter of 19.0 mm.
Continue wrapping and securing the probe tip to the probe shaft using tape.
6
Check That The Probe Tip's Outer Diameter Is 19.0 mm
Verify the 19 mm Diameter Probe Tip with a Ruler
Use a ruler to check that the probe tip's outer diameter is 19.0 mm.
For each cold probe, cut a 7.0 cm by 30.0 cm rectangle out of aluminum foil.
2
Attach Aluminum Foil To Probe As Shown.
Attach Aluminum Foil To Probe
Line up the edge of the aluminum foil to the edge of each cold probe tip.
Tape the aluminum foil to the cold probe tip. IMPORTANT: Do not cover the flat (top) surface of the cold probe tip with aluminum foil.
Make a loop with the tape so that one side of the tape will stick to the aluminum foil and the other side of the tape will stick to the probe tip. IMPORTANTː Do not cover the aluminum foil with tape on the outside of the probe as this will insulate the electrical circuit so it will not work properly.
3
Wrap Loose Aluminum Foil Around Probe As Shown.
Wrap Loose Aluminum Foil Around Probe
Secure the loose aluminum foil on the probe tip.
4
Wrap Aluminum Foil Around Probe and Leave 3.0 cm Foil-Free at the End of the Probe Shaft.
Wrap Aluminum Foil Around Probe
Wrap the remaining aluminum foil around the probe shaft, leaving approximately 3.0 cm uncovered (foil-free) at the end of the probe shaft that will be inserted into the body of the Thermocoagulator Simulator.
4
Cold Probe Tips Should Appear As Shown.
Check Cold Probe Tips
When finished, the cold probe tips should appear as shown.
Cut the cardboard in the shape as shown. The 6.0 cm length of the taller rectangle is the circumference for the 19.0 mm diameter probe tip.
2
Place Tape Perpendicular to Probe Tip To Attach (As Shown).
Attach Probe Tip to Shaft
Tape the thinner end of the cardboard strip firmly to the probe shaft.
3
Place Tape Perpendicular to Probe Tip While Wrapping it Around the Shaft (As Shown).
Wrap Probe Tip Around Shaft
Wrap the strip around the probe shaft while taping along the way.
4
Line Up and Tape Together Edges of 6.0 cm Long Rectangle..
Line Up and Tape Edges of Rectangle
Line up and tape together the edges of the taller 6.0 cm long rectangle of the probe tip to create a circular probe tip with an outer diameter of 19.0 mm.
Continue wrapping and securing the probe tip to the probe shaft using tape.
Use a ruler to check that the probe tip's outer diameter is 19.0 mm.
5
Check That The Probe Tip's Outer Diameter Is 19.0 mm
Verify the 19 mm Diameter Probe Tip with a Ruler
Use a ruler to check that the probe tip's outer diameter is 19.0 mm.
Cut the cardboard in the shape as shown. The 8.0 cm length of the taller rectangle is the circumference for the 25.0 mm diameter probe tip.
2
Place Tape Perpendicular to Probe Tip To Attach (As Shown).
Attach Probe Tip to Shaft
Tape the thinner end of the cardboard strip firmly to the probe shaft.
3
Place Tape Perpendicular to Probe Tip While Wrapping it Around the Shaft (As Shown).
Wrap Probe Tip Around Shaft
Wrap the strip around the probe shaft while taping along the way.
4
Tape Edges of Probe Tip Together
Line Up and Tape Edges of Rectangle
Line up and tape together the edges of the taller 8.0 cm long rectangle of the probe tip to create a circular probe tip with an outer diameter of 25.0 mm.
Continue wrapping and securing the probe tip to the probe shaft using tape.
5
Check That The Probe Tip's Outer Diameter Is 25.0 mm
Verify the 25 mm Probe Tip Diameter with a Ruler
Use a ruler to check that the probe tip's outer diameter is 25.0 mm.
For each hot probe, cut a 9.0 cm by 30.0 cm rectangle out of aluminum foil.
2
Attach Aluminum Foil To Probe As Shown.
Attach Aluminum Foil To Probe
Place the probe tip and shaft around 5.0 cm down from the edge of the foil.
3
Wrap Aluminum Foil To Probe As Shown.
Wrap Aluminum Foil Around Probe
Wrap the foil gently over the tip while pressing down on the probe tip outline. The probe tip outline should project slightly from the rest of the aluminum-foil covered probe tip to leave an impression of the treated area on the clay cervix model.
4
Wrap Aluminum Foil Around Probe and Leave 3.0 cm Foil-Free at the End of the Probe Shaft As Shown.
Wrap Aluminum Foil Around Probe
Wrap the remaining aluminum foil around the probe shaft, leaving approximately 3.0 cm uncovered (foil-free) at the end of the probe shaft that will be inserted into the body of the Thermocoagulator Simulator.
5
Hot Probe Tips Should Appear As Shown.
Check Hot Probe Tips
When finished, the hot probe tips should appear as shown.
This section explains how to construct the augmented feedback feature of the Thermocoagulator Simulator. The purpose of this targeted feedback is to alert the learner if the thermocoagulator probe shaft, which has a maximum temperature of 43 degrees Celsius, comes into contact with the inner vagina, and thereby, exposes the patient to a potential thermal injury.
Connect the First Alligator Clip from the Exposed Wire of the Black Insulated End of the Buzzer to the Negative Lead of the 9 V Battery.
Connect First Alligator Clip to Buzzer and Battery
Form a loop of the exposed wire of the black insulated end of the buzzer. TIP: Use the optional wire stripper to remove the colored plastic insulation covering the wire.
Clip an alligator clip on the exposed wire loop of the black insulated end of the buzzer. TIP: Clip the alligator clip perpendicular to the longitudinal axis of the exposed wire loop.
Connect the alligator clip from the exposed wire on the black insulated end of the buzzer to the negative lead of a 9 V battery.
2
Verify First (Black) Alligator Clip is Connected To The Proper Battery Lead By Attaching a Second (Red) Alligator Clip to the Opposite (Unused) Lead of the 9V Battery.
Verify First Alligator Clip Is Connected To The Proper Battery Lead
Attach a second alligator clip to the exposed wire of the red insulated end of the buzzer to the positive lead of the 9V battery.
If the buzzer makes a sound, then the alligator clips are connected to the proper battery lead.
If the buzzer does not make a sound, then switch the alligator clips to the opposite battery leads. The buzzer should now make a sound. If the buzzer still does not make a sound, try using a new battery or a different buzzer.
Disconnect the second alligator clip (which is attached to the exposed wire of the red insulated end of the buzzer) from the lead of the 9V battery.
3
Connect Second (Red) Alligator Clip to the Non-Taped Aluminum Foil of the Vaginal Canal of the Gynecologic Simulator
Connect Second Alligator Clip to Gynecologic Simulator
Connect the second alligator clip (attached to exposed wire of the red insulated end of the buzzer) to the exposed (non-taped) aluminum foil of the Vaginal Canal of the Gynecologic Simulator.
4
Attach First Alligator Clip To An Exposed Wire Looped Around the Proximal Probe Shaft.
Attach Two Alligator Clips to Thermocoagulator Simulator
Cut a small length of small gauge wire.
Loop and twist together the two ends of the small gauge wire around the aluminum foil covering the proximal probe shaft of the Thermocoagulator Simulator.
Attach one alligator clip to the wire loop around the proximal probe shaft.
Wind this alligator clip down the front of the Thermocoagulator Simulator and around the handle of the Thermocoagulator Simulator.
Tape a section of the alligator clip that winds around the handle of the Thermocoagulator Simulator.
Attach a second alligator clip to the free end of the alligator clip attached to the wire loop around the proximal probe shaft.
5
Connect (White) Alligator Clip from Thermocoagulator Simulator to Battery Lead
Connect Alligator Clip from Thermocoagulator Simulator to Battery Lead
Connect the alligator clip from the Thermocoagulator Simulator to the other (unused) lead of a 9 V battery.
IMPORTANT: Please put on gloves to prevent you from directly touching any material which can conduct a live electrical circuit.
Test the augmented feedback circuit by placing the Thermocoagulator Simulator probe tip on the aluminum foil simulating the vaginal sidewall of the Gynecologic Simulator. The buzzer should now make a soundǃ
The Learner Uses a Cellphone Camera to Take Pre- and Post-Treatment Photos of the Cervix.
The innovative Thermocoagulator Simulator Mobile App, was programmed in MIT App Inventor by Jude Barnabas, an Ugandan Medical Maker, and is designed to simulate the Liger Medical HTU-110 Thermocoagulator™ user interface, light illumination feature, and sounds heard during thermal ablation. This mobile app also directs the user to use the cellphone camera to take pre- and post-treatment photos of the cervix for the self-assessment framework.
Type in "Thermocoagulator Simulator" in the search bar at the top.
Select the Thermocoagulator Simulator app which displays the Medical Makers logo as the app icon.
Press on Install to install the Thermocoagulator Simulator app.
When ready, press on the Thermocoagulator Simulator app icon to open the app.
Noteː In the next phase, we will be developing an additional feature of the Thermocoagulator Simulator Mobile App to simulate the user interface for a thermocoagulator device with a hot probe. For now, the same user interface in the Thermocoagulator Simulator Mobile App will be used for skills training for both cold and hot probes.
Sections of the STARS - Cervical Cancer Screening and Treatment module are copied or adapted from: Training of health staff in VIA, HPV detection test and cryotherapy - Facilitators' guide. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC-BY-NC-SA-3.0 IGO; and WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. Geneva: World Health Organization; 2019. Licence: CC-BY-NC-SA-3.0 IGO. The World Health Organization (WHO) is not responsible for the content or accuracy of any translation. The original English edition shall be the binding and authentic edition.
↑HTU-IFU-002 TC Thermocoagulator Instructions for Use Rev B 04/2021 CN 0354 [product insert]. Liger Medical; 2021.