Advanced assessment of a novel 3D-printed LLETZ simulation model

Background Traditional surgical training methods, such as "learning-by-doing," raise ethical and methodological concerns, particularly for procedures such as LLETZ which are frequently performed by gynecology residents. To improve training and reduce patient risk, a novel 3D-printed 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. This study aimed to address these gaps by comparing the in-house developed simulator to a commercial model using objective metrics, expert video assessments, and participant feedback. Methods A single-center study was conducted at the University Hospital Wuerzburg between June 2022 and October 2023. 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 advantages over the commercial model. Higher R0 resection rates were achieved in the third and fourth attempts (100% vs. 83.3%, p < 0.05; 96.7% vs. 73.3%, p < 0.05). LEEP scores indicated significantly better surgical precision and learning progression from the fourth attempt onward (0.867 vs. 0.433, p < 0.05 and 1.200 vs. 0.167, p < 0.001). Blinded video evaluations by two senior experts confirmed these findings, showing higher checklist, GRS, and overall mean scores for the in-house simulator from the second or third attempt onward (all p-values < 0.05). Participant feedback further supported these results, highlighting improved confidence, skills, and 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. By promoting higher resection quality, improved surgical precision, and greater participant confidence, the simulator presents a valuable advancement in LLETZ training. Its integration into gynecological education could enhance surgical competency while addressing ethical concerns associated with traditional training methods.