Caption underneath

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.

Thermocoagulator Simulator[edit | edit source]

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.

Materials[edit | edit source]

  • Corrugated Cardboard
  • Scissors (sturdy enough to cut cardboard)
  • Pencil
  • Ruler
  • 2 Elastic Bands
  • 2 Toothpicks
  • Aluminum Foil
  • Tape
  • Android Mobile Phone with Thermocoagulator Simulator App

Assembly Instructions[edit | edit source]

Annotations:
  • 0:18: 1 - Base
  • 0:52: 2 - Body
  • 4:39: 3 - Probe Shaft
  • 5:13: 4A - 16.0 mm Flat Cold Probe
  • 6:23: 4B - 19.0 mm Flat Cold Probe
  • 7:36: 4C - Cold Probe Augmented Feedback
  • 8:38: 4D - 19.0 mm Hot Probe
  • 9:54: 4E - 25.0 mm Hot Probe
  • 11:31: 4F - Hot Probe Augmented Feedback
  • 12:29: 5 - Use with Phone

Base[edit | edit source]

1
Cut Out Base As Shown (1 grid square = 1 cm).
Cut Out Base
Cut out base (rectangle with three tabs) as shown.
2
Measure and Cut a 4.0 cm Slot As Shown (1 grid square = 1 cm).
Cut Slot
Measure and cut a 4.0 cm slot that lines up with the tab on the far right.
3
Insert Tab Into Slot.
Insert Tab Into Slot
Roll the cardboard into a cylinder and insert the tab into the slot.
4
Secure with Tape.
Secure With Tape
Secure base with tape.

Body[edit | edit source]

1
Cut Out Body As Shown.
Cut Out Body
Cut out body as shown.
2
Create Three Holes and One Horizontal Slot In Body (1 grid square = 1 cm).
Create 3 Holes and 1 Slot
Create three 1.0 cm diameter holes and one horizonal slot in the center of the body as shown.
3
Make Two Pairs of Small Holes In Body (1 grid square = 1 cm).
Make 4 Small Holes
Use toothpick to make two pairs of small holes in the body on the shaded section.
4
Loop One Elastic In Each Pair of Small Holes (As Shown).
Loop Elastic Into Small Holes
Loop one elastic in each pair of small holes from the back of the body (the left side of each step is facing the viewer).
5
Make Straight Folds At 4 Sections (Indicated By Black Horizontal Lines).
Fold 4 Sections
Use a ruler to make straight folds in the body at the 4 measured sections (shown as 4 black horizontal lines).
6
Fold Body Into Uppercase M-Shape. Insert Tab Into Slot.
Fold Body Into M-Shape
  1. Fold body to form an uppercase M-shape. TIP: The three 1.0 cm diameter holes should line up together.
  2. Insert the tab into the slot.
7
Mark Base on Body (Shown In Blue).
Mark Base on Body
On the section of the body with no holes, line up the base in the center and mark its general position as shown.
8
Remove the Tab From the Slot and Cut Out The Two Curved Marks.
Cut Out Curved Marks
Remove the tab from the slot and cut out the two curved marks.
9
Insert Base and Tab Into Body.
Insert Base and Tab Into Body
  1. Insert the base into the cut out marks on the body.
  2. Re-insert the tab into the slot.
10
Tape the Folded and Layered Cardboard Sections Together.
Tape Folded Sections Together
Tape the folded and layered cardboard sections together.

Probe Shaft[edit | edit source]

1
Cut Out Shaft As Shown (1 grid square = 1 cm).
Cut Out Shaft
Cut a 3.0 cm by 23.0 cm rectangle out of cardboard as shown.
2
Roll Into Cylinder As Shown.
Roll Into Cylinder
Roll the rectangle into a 1.0 cm diameter, 23.0 cm long cylinder as shown.
3
Secure Shaft With Tape As Shown.
Secure Shaft With Tape
  1. Secure with tape along the 1.0 diameter shaft as shown.
  2. Repeat Steps 1-3 three times to make a total of 4 probe shafts.

16.0 mm Diameter Cold Probe Flat Tip[edit | edit source]

1
Cut Out Probe Tip As Shown.
Cut Out Probe Tip
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
  1. Wrap the strip around the probe shaft while taping along the way.
  2. 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
  1. 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.
  2. 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.

19.0 mm Diameter Cold Probe Flat Tip[edit | edit source]

1
Cut Out Probe Tip (As Shown).
Cut Out Probe Tip
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
  1. Wrap the strip around the probe shaft while taping along the way.
  2. 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
  1. 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.
  2. 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.

Cold Probe Augmented Feedback Feature[edit | edit source]

1
Cut Out Aluminum Foil As Shown.
Cut Out Aluminum Foil
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
  1. Line up the edge of the aluminum foil to the edge of each cold probe tip.
  2. 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.
  3. 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.

19.0 mm Diameter Hot Probe Flat Tip[edit | edit source]

1
Cut Out Probe Tip (As Shown).
Cut Out Probe Tip
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
  1. 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.
  2. Continue wrapping and securing the probe tip to the probe shaft using tape.
  3. 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.

25.0 mm Diameter Hot Probe Flat Tip[edit | edit source]

1
Cut Out Probe Tip (As Shown).
Cut Out Probe Tip
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
  1. 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.
  2. 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.

Hot Probe Augmented Feedback Feature[edit | edit source]

1
Cut Out Aluminum Foil As Shown.
Cut Out Aluminum Foil
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.

Use with Phone[edit | edit source]

1
Mark 5.0 cm from Bottom of Thermocoagulator Simulator (As Shown).
Mark Body
Measure and mark 5.0 cm from the bottom edge of the Thermocoagulator Simulator (as shown).
2
Position a Toothpick Next to the Cellphone at the 5.0 cm Mark (As Shown).
Position Phone
  1. Place the cellphone in the center of the Thermocoagulator Simulator as shown.
  2. Position a toothpick next to the cellphone at the 5.0 cm mark.
3
Insert Toothpicks Through Body (As Shown).
Insert Toothpicks
  1. Use the toothpick to puncture through the body at a 45 degree angle to come out next to then base.
  2. Repeat Steps #2 and #3 for the second toothpick on the opposite side of the cellphone.
4
Slide Phone Into Elastics, Starting With the Lower Elastic (As Shown).
Slide Phone Into Elastics
Slide the cellphone into the elastics, starting with the lower elastic.
5
Wrap the Bottom Elastic Around the Toothpicks Until the Cellphone is Tightly Secured in Place (As Shown).
Secure Phone With Elastics
Wrap the bottom elastic around the toothpicks until the cellphone is tightly secured in place.
6
Insert Probe Into Body (As Shown).
Insert Probe Into Body
Insert the desired probe shaft into the 1.0 cm hole in the front of the Thermocoagulator Simulator which is almost ready for use!

Augmented Feedback Feature[edit | edit source]

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.

Materials[edit | edit source]

Supplies Used to Build the Augmented Feedback Circuit

You will need the following materials:

  • Optionalː Wire Stripper
  • Alligator Clips (minimum 4)
  • Buzzer
  • 9 V Battery
  • Non-Insulated, Small Gauge Wire
  • Scissors
  • Tape
  • Ruler

Not shown in imageː

Assembly Instructions[edit | edit source]

1
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
  1. 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.
  2. 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.
  3. 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
  1. 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.
  2. If the buzzer makes a sound, then the alligator clips are connected to the proper battery lead.
  3. 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.
  4. 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
  1. Cut a small length of small gauge wire.
  2. 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.
  3. Attach one alligator clip to the wire loop around the proximal probe shaft.
  4. Wind this alligator clip down the front of the Thermocoagulator Simulator and around the handle of the Thermocoagulator Simulator.
  5. Tape a section of the alligator clip that winds around the handle of the Thermocoagulator Simulator.
  6. 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
  1. Connect the alligator clip from the Thermocoagulator Simulator to the other (unused) lead of a 9 V battery.
  2. IMPORTANT: Please put on gloves to prevent you from directly touching any material which can conduct a live electrical circuit.
  3. 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

Thermocoagulator Simulator Mobile App[edit | edit source]

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.

Equipment[edit | edit source]

  • Android Smartphone
  • Internet Connection

Android App Installation Instructions[edit | edit source]

  1. Open the Google Play Store application.
  2. Type in "Thermocoagulator Simulator" in the search bar at the top.
  3. Select the Thermocoagulator Simulator app which displays the Medical Makers logo as the app icon.
  4. Press on Install to install the Thermocoagulator Simulator app.
  5. 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.

References[edit | edit source]

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.

Template:Rferences

Page data
Part of STARS - Cervical Cancer Screening and Treatment
Type Medical equipment
Keywords cervical cancer, screening, treatment, visual inspection with acetic acid, thermal ablation, cervical pre-cancer lesions
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Jocelyn Xu, Medical Makers
Published 2021
License CC-BY-SA-4.0
Impact Number of views to this page and its redirects. Updated once a month. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 1,016
  1. HTU-IFU-002 TC Thermocoagulator Instructions for Use Rev B 04/2021 CN 0354 [product insert]. Liger Medical; 2021.
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