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Evaluation of a Low-Fidelity Surgical Simulator for Large Loop Excision of the Transformation Zone (LLETZ)
Erin B Wilson1, Michael M Beckmann, David G Hewett
1From Mater Research (E.B.W.), University of Queensland School of Medicine; Mothers Babies and Women's Health Services (M.M.B.), Mater Health Services, South Brisbane Mater Research (M.M.B.), Betty McGrath Research Fellow (M.M.B.), University of Queensland School of Medicine; University of Queensland School of Medicine (D.G.H.); Queen Elizabeth II Jubilee Hospital (D.G.H.), Brisbane, QLD, Australia; School of Medicine and Public Health (B.C.J.), University of Newcastle, Callaghan, New South Wales; Mater Health Services, South Brisbane (S.J.); and University of Queensland School of Medicine (S.J.), QLD, Australia.
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.
