Evaluation of a Low-Fidelity Surgical Simulator for Large Loop Excision of the Transformation Zone (LLETZ)

Introduction: Large loop excision of the transformation zone (LLETZ) is a common gynecological treatment for cervical dysplasia but can be challenging to teach. There is no widely adopted simulator for this procedure in Australia, so a new low-fidelity simulator was designed and evaluated. Method: A simulator for a LLETZ procedure was developed. Doctors (N = 29), varied in experience level in gynecology at a tertiary hospital, performed a LLETZ procedure using the simulator. The procedures were filmed, and two independent assessors rated the deidentified videos. The assessment involved a checklist (of crucial procedural steps) and global rating scale to evaluate whether the simulator facilitated the demonstration of LLETZ procedure skills. Participants completed a questionnaire evaluating the performance and utility of the simulator to determine participant perceptions of simulator realism and acceptability. Results: The participant questionnaire revealed positive evaluations of realism and acceptability of the simulator. Performance scores were significantly different across experience levels (P < 0.001) with post hoc pairwise comparison between levels confirming significant differences between each group in assessed simulator performance for global rating scale and overall performance scores. The interrater reliability of the assessors was high (0.84). Conclusions: A low-fidelity simulator for a LLETZ procedure seems to adequately demonstrate procedural performance reflecting doctor experience level. Participant questionnaire responses were positive, supporting further evaluation of the simulator for use in training.