Cumulative Sum Analysis of Learning Curve Process for Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy.

Autor:	Mereu L; Division of Obstetrics and Gynecology, Department of General Surgery and Medical-Surgical Specialism (Dr. Mereu), University of Catania, P.O. 'G Rodolico', Catania, Italy. Electronic address: liliana.mereu@unict.it., Pecorino B; Division of Gynecology and Obstetrics, (Drs. Pecorino, Ferrara, D'Agate, and Scollo), Cannizzaro Hospital, Catania, Italy., Ferrara M; Division of Gynecology and Obstetrics, (Drs. Pecorino, Ferrara, D'Agate, and Scollo), Cannizzaro Hospital, Catania, Italy., Siniscalchi M; Department of Engineering and Architecture (Drs. Siniscalchi and Garraffa), Kore University, Enna, Italy., Garraffa G; Department of Engineering and Architecture (Drs. Siniscalchi and Garraffa), Kore University, Enna, Italy., D'Agate MG; Division of Gynecology and Obstetrics, (Drs. Pecorino, Ferrara, D'Agate, and Scollo), Cannizzaro Hospital, Catania, Italy., Scollo P; Division of Gynecology and Obstetrics, (Drs. Pecorino, Ferrara, D'Agate, and Scollo), Cannizzaro Hospital, Catania, Italy; Kore University, Enna, Italy.
Jazyk:	angličtina
Zdroj:	Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2023 Jul; Vol. 30 (7), pp. 582-586. Date of Electronic Publication: 2023 Mar 24.
DOI:	10.1016/j.jmig.2023.03.013
Abstrakt:	Study Objective: This study aimed to evaluate the learning curve of vaginal natural orifice transuminal endoscopic surgery (vNOTES) hysterectomy in expert minimal invasive and vaginal surgery team. Design: This is a cohort study on a retrospective analysis. Setting: Department of Obstetrics and Gynecology of Cannizzaro Hospital in Catania Italy. Patients: First 50 women underwent vNOTES hysterectomy between February 2021 and February 2022. Intervention: vNOTES hysterectomy performed by a team with optimal skills in laparoscopic and vaginal surgery. Measurement and Main Results: Primary outcome was surgical time. Secondary outcomes were intraoperative and postoperative complications, length of hospitalization, and first 24-hour postoperative pain. All patients underwent hysterectomy for benign indications: 27 fibromatosis, 13 metrorrhagia, and 10 precancerous. Concomitant procedures have been bilateral adnexectomy in 35 cases and bilateral salpingectomy in 15 cases. The median age was 51 years (range, 42-64). Median body mass index was 26 kg/m 2 (range, 21-42). The median operative time was 75 minutes (range, 40-110). The median hospital stay was 2 days (range, 1-4). There was 1 intraoperative adverse event (bladder lesion) and 1 postoperative grade 3 complication (hemoperitoneum). The median visual analog scale score for pain assessment during the first 24 hours after surgery was 3 (range, 1-6). The experience in our surgical center with the first 25 vNOTES hysterectomies showed an accumulation of initial experience in the first 5 cases with stable operating time and a gradual reduction of mean operating time in the subsequent 17 surgeries. The learning curve plotted by cumulative sum analysis shows 3 phases: phase 1 of competence (cases 1-5), phase 2 of proficiency (cases 6-26), and phase 3 of mastering the procedure (after the 31st case) with the management of more complex cases. Conclusion: vNOTES hysterectomy is a feasible and reproducible approach for benign indications with a short learning curve and low rate of perioperative complications. For a team skilled in minimally invasive surgery, 5 cases are required to rich competence and 25 to rich proficiency in vNOTES hysterectomy. Mastering phase, with the introduction of more complex cases, should be addressed after 30 surgeries. (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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