Comparative validation of a cost-effective in-house 3D-printed LLETZ simulator versus a commercial training model.
Clinical Snapshot
PICO Framework
| P — Population | 60 medical students without prior LLETZ experience and 10 gynecology residents with prior exposure |
| I — Intervention | Training on novel in-house 3D-printed LLETZ simulator |
| C — Comparator | Training on commercial LLETZ simulator |
| O — Outcomes | LEEP scores, R0 resection rates, blinded video assessment scores, participant satisfaction questionnaires |
Bottom Line
This randomised trial demonstrates that a novel 3D-printed LLETZ simulator significantly outperforms commercial alternatives in training effectiveness. The in-house simulator produced larger learning effect sizes (η2 = 0.227 vs 0.10), higher R0 resection rates (100% vs 83.3%), and superior expert assessment scores from the third training attempt onwards. While methodological limitations include unclear randomisation procedures and missing confidence intervals, the large effect sizes (Cohen's d > 1.0) suggest clinically meaningful improvements in surgical training outcomes. For Australian gynecology training programs, this cost-effective approach could enhance LLETZ skill acquisition while reducing patient risk during the learning curve. The comprehensive assessment methodology, including objective performance measures and blinded expert evaluation, strengthens the validity of these findings for surgical education applications.
Key Findings
P Value: p = 0.002 for between-group comparison at fifth attempt
Effect Size: Larger effect size for in-house simulator (η2 = 0.227) versus commercial simulator (η2 = 0.10)
Primary Outcome: LEEP scores showed statistically significant improvement over five attempts for both simulators
Nnt Or Sensitivity: R0 resection rate: 100% vs 83.3% (third attempt), 96.7% vs 73.3% (fourth attempt) favoring in-house simulator
Confidence Interval: Not reported
Clinical Application
Requires 3D printing capability and initial development investment, but cost-effective long-term Highly relevant to Australian gynecology training programs. Could support RANZCOG training requirements and reduce patient exposure during learning curve Medical students and gynecology trainees learning LLETZ procedures
Abstract
PURPOSE: Traditional surgical training methods such as "learning-by-doing" raise ethical and methodological concerns. To improve training and reduce patient risk, a 3D-printed LLETZ simulator was developed. While initial studies showed advantages over a conventional model, they were limited to medical students and lacked comparison with a commercially available simulator. METHODS: A single-center study was conducted at the University Hospital Wuerzburg. 60 medical students without prior LLETZ experience and 10 gynecology residents with prior exposure were randomly assigned to train on either a commercial or the novel in-house simulator. Each participant performed five electrosurgical excisions. Performance was evaluated using LEEP scores, resection status (R0 resections), and blinded video assessments by two senior clinicians. Additionally, participants completed questionnaires, to capture subjective training impressions. RESULTS: The in-house simulator demonstrated superior performance compared to the commercial model. When analyzed separately, changes in LEEP scores over the five attempts were statistically significant for both simulators. The effect size was larger for the in-house simulator (η2 = 0.227) than for the conventional simulator (η2 = 0.10). Within-group analysis revealed no significant pairwise differences across all attempts for the commercial simulator. In contrast, several pairwise comparisons remained statistically significant for the in-house simulator (attempts 1 vs. 3, 1 vs. 4, 2 vs. 5, and 1 vs. 5), all with large effect sizes (Cohen's d > 1.1). Between-group comparison of individual LEEP scores showed a statistically significant difference in the fifth attempt (p = 0.002), with a large effect size (Cohen's d = 1.01) favoring the in-house simulator. Higher R0 resection rates were observed with the in-house simulator in the third (100% vs. 83.3%) and fourth attempts (96.7% vs. 73.3%). Blinded video assessments by two senior experts confirmed these findings, demonstrating higher checklist, Global Rating Scale (GRS), and overall mean scores for the in-house simulator from the third attempt onward (all p < 0.05; all Cohen's d > 0.8). Participant feedback further supported these results, indicating improved confidence, technical skills, and perceived educational value. CONCLUSION: This study demonstrated that the novel in-house 3D-printed simulator significantly outperformed the commercial model in objective surgical performance, learning progression and user satisfaction.
References
- 1.Scherer-Quenzer, A. C., Reinhart, K., Diessner, J., Altides, A., Buechel, J., Blau-Schneider, B., Sauer, S. T., Deschler-Baier, B., Woeckel, A., & Kiesel, M. (2026). Comparative validation of a cost-effective in-house 3D-printed LLETZ simulator versus a commercial training model. Archives of Gynecology and Obstetrics. https://doi.org/10.1097/SLA.0b013e3180f61b09
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