The effect of hands-on training on surgical performance of large loop excision of the transformation zone in a surgical training model

Background: Large Loop Excision of the Transformation Zone (LLETZ) is one of the most common procedures in operative gynecology and it is a routine part of the surgical training program of residents. There is, however, no established and standardized method of teaching residents how to perform LLETZ.

Objective: To assess the improvement of surgical skills during repeated hands-on trainings of LLETZ in a surgical training model.

Study Design: Surgical novices and experts were shown a LLETZ training video and then performed three LLETZ training sessions on consecutive days. Surgical skills were assessed by Objective Structured Assessment of Technical Skills (OSATS). Global rating scale (GRS), confidence (CON), fragmentation rate (FR), and performance time (PT).

Results: 68 probands (58 novices, 10 experts) were recruited. GRS, 2.3 ± 1.3 (median ± SD) vs. 1.4 ± 0.6, p < 0.001; CON, 2.7 ± 0.9 vs. 1.6 ± 0.6, p < 0.001; FR, 81% vs. 100%, p < 0.001; PT, 152 ± 33 vs. 120 ± 27 seconds, p = 0.006; and OSATS scores, 18.8 ± 1.3 vs. 19.1 ± 1.1, p = 0.2 of novices improved from session 1 to session 3. OSATS showed construct validity with metric scores (GRS, 1.1 ± 0.3 vs. 2.3 ± 0.8, p < 0.001; CON, 1.0 ± 0.0 vs. 2.7 ± 0.9, p < 0.001; PT 125 ± 30 vs. 152 ± 33 seconds, p = 0.02; OSATS scores, 19.6 ± 0.7 vs. 18.8 ± 1.3, p = 0.02) reliably discriminating between experts and novices. Intra- and inter-observer variabilities across probands were 0.99 ± 0.03 and 0.64 ± 0.10, respectively. OSATS scores were independent of handedness, gender, and regular sports activity in univariate and multivariate analyses.

Conclusion: Repeated hands-on trainings improve surgical performance of LLETZ in a surgical training model with construct validity.