Learning Curve, Training, and Operator Experience in Vaginoscopic Hysteroscopy: A Systematic Review

Vaginoscopic hysteroscopy, also known as the no-touch technique, is widely used in outpatient gynecologic practice, but the experience required to achieve reproducible competence remains uncertain. This systematic review synthesized clinical and simulation-based evidence on learning curves, training, operator experience, technical performance, and competency assessment in vaginoscopic hysteroscopy. Eligible reports explicitly described vaginoscopic or no-touch access and evaluated at least one learning-related outcome. The included studies differed substantially in design, operator experience, training context, and definitions of technical performance. Clinical reports suggested improvement in procedural efficiency and success with experience, while simulation-based studies identified differences in technical performance between operators of varying experience. However, procedural speed, overall outpatient hysteroscopy proficiency, and vaginoscopy-specific competence were not assessed consistently, and the available evidence did not establish a validated, universal case-number threshold for independent vaginoscopic cervical access. No included clinical study established an individualized competency threshold for vaginoscopic access using sequential learning-curve methodology. These findings favor multidimensional, performance-based assessment rather than reliance on procedure counts alone and support prospective studies with standardized success criteria and individualized monitoring.