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A standardized simulation training program to type 1 loop electrosurgical excision of the transformation zone: a prospective observational study

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate a simulation-based standardized training program for type 1 loop electrosurgical excision procedure (LEEP) under direct colposcopic vision in postgraduate teaching.

Methods

Seventeen participants (five experienced and 12 novice surgeons) performed 170 simulated cervical excisional procedures. Each participant performed 10 type 1 (cone length between 8 and 10 mm) excisional procedures under direct colposcopic vision on a low-fidelity simulator. Length of specimen was measured after each excision allowing the surgeons a subsequent resection to ensure a cone length of more than 8 mm. Main outcome measures were cone length, specimen fragmentation, and a self-developed score (LEEP score), which allowed the simultaneous evaluation of both measured parameters.

Results

The precision of the excision showed statistically significant improvement in the novice group during the training procedures after five procedures [LEEP score 1.61 (SD 1.34) vs. 0.46 (SD 0.58); p = 0.023], while experts showed consistently high performance. Inexperienced surgeons performed more frequently cuts that were too deep than experienced surgeons (33/120, 27.5% vs. 4/50, 8%; p = 0.003).

Conclusions

Low-fidelity simulation training seems to be an effective method for learning the accurate cone length for a type 1 excision for novice surgeons. As excessive excisions are related with high risk for premature delivery in subsequent pregnancies, in our opinion, LEEP should be practiced in simulation training, especially before performing in woman of reproductive age.

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Acknowledgements

The authors would like to gratefully thank for Mrs. Sylvia Theobald and Mrs. Orsolya Takacs for they support in the preparation for the simulation training and for Mr. Marc Müller for assistance with Fig. 1.

Funding

The study received no funding.

Author information

Authors and Affiliations

  1. Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany

    Ferenc Zoltan Takacs, Christoph Gerlinger, Amr Hamza, Sebastian Findeklee, Ingolf Juhasz-Böss, Georg-Peter Breitbach, Erich-Franz Solomayer & Julia Caroline Radosa

Authors
  1. Ferenc Zoltan Takacs
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  2. Christoph Gerlinger
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  3. Amr Hamza
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  4. Sebastian Findeklee
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  5. Ingolf Juhasz-Böss
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  6. Georg-Peter Breitbach
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  7. Erich-Franz Solomayer
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  8. Julia Caroline Radosa
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Contributions

FZT: conception, design, acquisition, analysis and interpretation of data; draft. CG: analysis and interpretation, draft, review, and editing. AH: conceptualization, review, and editing. SF: acquisition of data, review, and editing. IJB: data analysis, review, and editing. GPB: acquisition of data, review, and editing. EFS: conceptualization, review, and editing. JCR: data interpretation, draft, review, and editing.

Corresponding author

Correspondence to Ferenc Zoltan Takacs.

Ethics declarations

Conflict of interest

JCR has received travel grants from Medac, Gedeon Richter, and Celgen; EFS received royalties from Roche, Amgen, Celgene, Tesono, Astra Zeneca, Pfizer, Storz, Erbe, Gedeon Richter, Ebsai, Medac, MSD, Vifoz, Teva, Ethicon, Saarland Tumor Center, Medconcept, AGE, AGO, DGGG, DEGUM, German Cancer Society, ESGE, Saarland Cancer Society, which were not linked to current research. All other authors declare that they have no conflicts of interest related to this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical board approval (Ethics Committee of Saarland 259/17) was issued and informed consent was obtained from each participant prior to recruitment.

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Takacs, F.Z., Gerlinger, C., Hamza, A. et al. A standardized simulation training program to type 1 loop electrosurgical excision of the transformation zone: a prospective observational study. Arch Gynecol Obstet 301, 611–618 (2020). https://doi.org/10.1007/s00404-019-05416-1

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  • DOI: https://doi.org/10.1007/s00404-019-05416-1

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