Systematic review and meta-analysis of the efficacy of simulation training in gynecologic laparoscopy

To evaluate the effectiveness of simulation-based training in gynecologic laparoscopy, compare the educational impact of box trainers (BT) and virtual reality (VR) simulators, and assess whether training effects differ according to participants' level of surgical experience.

PubMed, MEDLINE, and Embase were searched for studies published between 2015 and November 2025 evaluating simulation-based training in gynecologic laparoscopy.

A systematic review and meta-analysis were conducted following PRISMA guidelines. Eligible studies included laparoscopically naïve individuals, residents, or practicing gynecologic surgeons undergoing training with BT or VR simulators. The primary outcome was time to complete simulation tasks. Secondary outcomes included Objective Structured Assessment of Technical Skills (OSATS) scores, bleeding-related metrics, and instrument path length. Pooled pre-post effects were synthesized using random-effects models, with prediction intervals reported.

Sixteen studies involving 474 participants were included. Of these, 362 participants trained using BT and 112 using VR simulators. Simulation-based training was associated with significant improvements in task completion time, OSATS scores, bleeding-related metrics, and instrument path length. Meta-regression analyses showed no significant differences between simulator modalities for task completion time or OSATS outcomes. Participant experience influenced improvements in task completion time but not OSATS scores, which remained significantly improved after adjustment for experience level.

Simulation-based training in gynecologic laparoscopy was associated with improved technical performance within simulation environments. Improvements were observed with both BT and VR simulators and no significant difference between modalities was detected, although equivalence was not established. The low to very low certainty of evidence warrants cautious interpretation, and these simulation-based outcomes do not by themselves demonstrate clinical effectiveness. These findings nonetheless support the integration of simulation into gynecologic surgical training curricula and the implementation of cost-effective training strategies when advanced simulation technologies are not available.