Learning Curve, Training, and Operator Experience in Vaginoscopic Hysteroscopy: A Systematic Review

Vaginoscopic hysteroscopy, also known as the no-touch technique, is widely used in outpatient gynecologic practice, but the experience required to achieve reproducible competence remains uncertain.This systematic review synthesized clinical and simulation-based evidence on learning curves, training, operator experience, technical performance, and competency assessment in vaginoscopic hysteroscopy.Eligible reports explicitly described vaginoscopic or no-touch access and evaluated at least one learning-related outcome.The included studies differed substantially in design, operator experience, training context, and definitions of technical performance.Clinical reports suggested improvement in procedural efficiency and success with experience, while simulation-based studies identified differences in technical performance between operators of varying experience.However, procedural speed, overall outpatient hysteroscopy proficiency, and vaginoscopy-specific competence were not assessed consistently, and the available evidence did not establish a validated, universal case-number threshold for independent vaginoscopic cervical access.No included clinical study established an individualized competency threshold for vaginoscopic access using sequential learning-curve methodology.These findings favor multidimensional, performance-based assessment rather than reliance on procedure counts alone and support prospective studies with standardized success criteria and individualized monitoring.