Background: Laparoscopic gynecologic surgery requires complex psychomotor, visuospatial, bimanual coordination, and tissue-handling skills that are difficult to acquire exclusively through operating-room apprenticeship. Immersive virtual reality (iVR) and conventional virtual-reality (VR) simulators provide repeatable, measurable, and patient-independent environments in which trainees can practice technical skills before undertaking clinical procedures. This systematic review evaluates the effects of VR-based simulation on surgical skills, learning curves, transfer of skills to the operating room, and patient-safety-related outcomes in gynecologic laparoscopic surgery.

Methods: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and relevant trial literature considered for studies evaluating VR or immersive VR simulation for laparoscopic gynecologic training. Randomized controlled trials, prospective comparative studies, cohort studies, and systematic reviews/meta-analyses were considered. Outcomes included technical performance, operative time, errors, learning curves, transfer to live surgery, complications, blood loss, and other patient-related outcomes. Evidence synthesized narratively, with quantitative findings reported when published meta-analytic estimates were available.

Results: Evidence consistently indicates that VR simulation improves laparoscopic psychomotor performance and accelerates early skill acquisition, particularly among novices. Gynecology-specific studies demonstrated improved operative performance after VR training for salpingectomy and hysterectomy. A randomized hysterectomy study reported higher procedure-specific OSATS and VAS scores among VR-trained residents, although operative-time differences were not statistically significant and no differences detected in blood loss or direct complications. Broader laparoscopic meta-analyses demonstrate improved performance and shorter operative time compared with no training, while differences between VR and box trainers are less consistent. Patient-level safety evidence remains limited.

Conclusion: VR simulation represents a useful adjunct to structured gynecologic laparoscopic education, particularly during the early learning curve. However, current evidence does not establish that VR alone improves patient safety outcomes. Future trials should use standardized proficiency benchmarks, larger gynecologic samples, long-term retention measures, and patient-centered endpoints.