Simulation-Based Vaginal Natural Orifice Transluminal Endoscopic Surgery Training: Advancing Resident Surgical Education

Abstract

Objective:

To evaluate the effect of structured hands-on simulation training on obstetrics and gynecology (OB/GYN) residents’ knowledge, confidence, and procedural preference for vaginal natural orifice transluminal endoscopic surgery (vNOTES).

Methods:

This prospective, observational study was conducted between July and August 2022 at a single tertiary medical center. Twelve fourth-year OB/GYN residents completed a didactic online curriculum on adnexectomy and hysterectomy via vNOTES, followed by three monthly hands-on simulation labs using box trainers under direct faculty supervision. Residents’ confidence in key surgical steps and procedural preferences was assessed with pre- and post-simulation surveys. Faculty procedural assessments were recorded for each simulation.

Results:

A total of 49 procedural assessments were completed, including 23 adnexectomies and 26 hysterectomy procedures. Competence was achieved in hysterectomy and adnexectomy by 5 out of 12 and 2 out of 12 residents, respectively. Seven residents completed feedback surveys before and after the simulations. Residents reported a 33% increase in confidence performing anterior and posterior colpotomy. Confidence in transecting the uterosacral ligaments increased from 71% to 85% after simulations. Confidence in transecting the uterine artery via vNOTES doubled from 14% to 28% compared with the laparoscopic approach following simulation. Confidence in performing adnexectomy increased by 15% after simulation; however, there was a 14% reduction in the preference for choosing vNOTES for hysterectomy.

Conclusions:

Hands-on simulation in vNOTES enhances residents’ knowledge and confidence in performing key surgical steps of adnexectomy and hysterectomy. These findings support the integration of vNOTES simulation into residency training programs to improve surgical proficiency.