A novel virtual reality-based simulator for training in LLETZ procedures: Development and preliminary validation

Background Cervical intraepithelial neoplasia is commonly treated by large loop excision of the transformation zone (LLETZ), a technically demanding procedure associated with risks such as incomplete excision and cervical insufficiency. In view of patient safety and ethical concerns regarding “learning by doing,” simulation-based training is increasingly important in gynecologic education. To address the lack of a dedicated LLETZ simulator, we developed a virtual reality (VR) system specifically for LLETZ training, conceived as an open-source platform. Methods The central achievement of this work is a VR environment that provides a colposcopic view of the cervix, real-time tissue cutting with generation of a separate, inspectable cone specimen, and automated performance metrics. Senior consultants were invited to test the simulator to evaluate its face and content validity and its overall usefulness. Subsequently they completed a 14-item validation questionnaire and the 16-item Post-Study System Usability Questionnaire Short (PSSUQ-Short). Results Face validity was rated favourably for target anatomy and overall realism, whereas instrument handling and tissue response received more moderate scores. Content validity and educational value were judged positively, with high ratings for understanding procedural workflow, hand–eye coordination and cutting precision, and willingness to integrate the simulator into structured curricula. Usability ratings were likewise favourable across all PSSUQ domains. Conclusion This pilot study demonstrates the successful design of a VR-based LLETZ simulator that is feasible and educationally meaningful for training gynecology residents, and provides a promising foundation for further open development and optimisation.