Available online 6 October 2023, 102676

Author links open overlay panel, , , , , , ABSTRACT

Large loop excision of the transformation zone (LLETZ) of the uterine cervix is a surgical procedure very frequently performed. Simulation of LLETZ under colposcopic guidance has a major role in training practitioners. The objective was to present an ex vivo model of LLETZ.

Section snippetsINTRODUCTION

With more than 40,000 procedures per year, large loop excision of the transformation zone (LLETZ) of the uterine cervix is one of the most common surgical procedures performed in gynecological operating rooms [1]. However, this simple procedure can lead to a number of complications (and particularly obstetrical complications) that are directly related to the extent of the procedure [1]. The main risk is premature delivery, which increases significantly with the depth of the excision [2]. As

MATERIAL REQUIRED

The device (for a single unit):

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a 300 × 200 mm wooden plate

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a PVC tube, 120 mm long and 50 mm in diameter

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hot glue or superglue

The simulated surgical site:

Surgical equipment:

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a simple operating field

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diathermic loops of different diameters

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claw forceps

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a suction tube

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an electrosurgical generator

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a suction system

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a colposcope

DEVICE ASSEMBLY

First, 10 mm holes must be drilled in the PVC tube 15 mm from the proximal end, in order to accommodate the suction hose (photo 1). The tube is attached to the wooden board at both ends, with the proximal end of the tube raised by 30 to 40 mm (photo 1). The distal end of the wooden board accommodates the ox tongue as the simulated surgical site (photo 1). The tongue's size facilitates attachment of the electric scalpel's neutral electrode plate (photo 1). The device is then placed on an

PRIOR TRAINING

We first created a simple practice procedure for adjusting the colposcope. Simple words are written in a small font (i.e. not legible to the naked eye) on a sheet of paper (photo 3). The sheet is placed at the distal end of the PVC tube, so that the learner can try to focus on the words (Movie 1). One of the difficulties encountered by beginners is perfect focus, so that LLETZ can be performed under optimal visual conditions. This exercise enables the student to learn how to obtain a clear,

PERFORMING THE PROCEDURE

The colposcope is placed in front of the simulator. A loop is selected (in accordance with instructions given beforehand), and the suction system is switched on. The surgical procedure is easily performed through the PVC tube, aided by the colposcope's lumen. LLETZ can be performed using standard techniques and any desired loop diameter. Suction of the smoke provides better visibility, just as in real-life LLETZ. For the simulation to be of practical interest, the user must be given a target

DISCUSSION

As the last stage in the secondary prevention of cervical cancer, LLETZ is one of the most frequently performed procedures in gynecological surgery. The main indications for LLETZ are the in situ removal of high-grade intraepithelial lesions and adenocarcinoma of the uterine cervix [9]. While the procedure is not technically difficult, it must be mastered because the complications can be significant. Firstly, the risk of recurrence is between 3% and 11% [1]. Early and late hemorrhage is also a

CONCLUSION

Our LLETZ simulator appears to be a realistic, reproducible, low-cost tool for learning in a safe environment. In our experience, this device rapidly shortens the learning curve for practitioners wishing to perform LLETZ and should be systematically included in surgical training programs.

Declaration-of-competing-interests

none

Funding

This research did not receive any specific funding from agencies or organizations in the public, commercial, or not-for-profit sectors

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