Archives of Gynecology and Obstetrics

, Volume 299, Issue 3, pp 817–824 | Cite as

Introduction of a learning model for type 1 loop excision of the transformation zone of the uterine cervix in undergraduate medical students: a prospective cohort study

  • Ferenc Zoltan TakacsEmail author
  • Julia Caroline Radosa
  • Christoph Gerlinger
  • Sebastian Findeklee
  • Ingolf Juhasz-Böss
  • Erich-Franz Solomayer
  • Amr Hamza
Gynecologic Oncology



We address the impact of applying loop electrosurgical excision procedure (LEEP) under direct colposcopic vision teaching to our undergraduates using a self-developed simulation model and a standardized assessment to evaluate the progress of learning.


The undergraduate teaching module was composed of a theoretical course on cervical dysplasia, colposcopy, electrosurgery and excisional procedures of the uterine cervix. This was followed by hands-on practical rounds. During the hands-on practice the students performed five “type 1” LEEP under direct colposcopic vision on the self-developed simulator. Based on specimen fragmentation and excision accuracy a score system was established. The students were asked to answer a course evaluation questionnaire.


The accuracy of the excisions showed a statistically significant improvement during the five training procedures (excision depth 7.34 ± 1.60–8.54 ± 1.67 mm, p = 0.0041; deviation from target cone thickness 0.88 ± 1.16–0.13 ± 0.94 mm, p = 0.0116). The fragmentation of the conus decreased (2.57 ± 1.26–1.29 ± 0.60 pieces, p < 0.0001). All this led to a general improvement of the LEEP score (2.59 ± 1.93–0.84 ± 1.03, p = 0.001). The student’s questionnaire revealed a subjective satisfaction and improvement of their knowledge in pathomechanism, diagnosis and therapy of cervical pathologies.


Undergraduate surgical training, in cervical excisional procedure, is a successful method in improving the students’ perception and management of cervical pathologies.


Simulation training Teaching LEEP LLETZ Cone biopsy Colposcopy 



The authors would like to gratefully acknowledge the language editing for Ghada Hamza.

Author contributions

FZT: project development, data collection and analysis, manuscript writing. JCR: review and editing. CG: data analysis, review and editing. SF: data collection, review and editing. IJ-B: review and editing. EFS: review and editing. AH: review and editing.

Compliance with ethical standards

Ethical approval

The study was approved by the Ethics Committee of Saarland (no: 259/17)

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynecology, Obstetrics, and Reproductive MedicineUniversity Medical School of SaarlandHomburgGermany

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