An Open-Source VR Training System for Gynecological LLETZ Procedures

Abstract

Cervical cancer is the fourth leading cause of cancer-related mortality among women worldwide. A common treatment for precancerous cervical lesions is the invasive surgical procedure known as Large Loop Excision of the Transformation Zone (LLETZ). During LLETZ, abnormal tissue is removed using an electrically activated wire loop with minimal tactile resistance. Traditional training relies heavily on observation and supervised practice on patients, raising ethical concerns and limiting learning opportunities. As the electrically activated loop encounters negligible tactile resistance during excision, effective VR simulation of LLETZ is possible without the need for high-fidelity force feedback.We present an open-source VR training system that addresses ergonomic and interaction challenges through a user-centered design process conducted in close collaboration with clinical experts. Core features include enhanced visual realism through speculum visualization with depth cues, multimodal feedback for loop activation (visual smoke and sound), and hysteresis-based switching between room view and colposcope magnification to prevent unintended mode changes. The system further provides a dual-mode interface that separates immersive VR-based surgical training from desktop- or tablet-based analytics, reducing cybersickness for trainees while enabling asynchronous expert consultation. Critical errors that would severely endanger the patient automatically terminate the simulation and trigger explanatory feedback.This work demonstrates how systematically designed interfaces and interaction concepts can mitigate VR ergonomic limitations without relying on expensive hardware, offering a transferable and cost-efficient methodology for medical training, particularly in resource-constrained settings.

Keywords: VR, Gynecology Surgery Simulation, User-centered Design, Large Loop Excision Of The Transformation Zone (LLETZ), Multimodal Feedback

DOI: 10.54941/ahfe1007546