The Learning Curve of Laparoendoscopic Single-Site Surgery in Benign Gynecological Diseases

Abstract

Objective

To analyze and draw the learning curve of laparoendoscopic single-site surgery (LESS) in various benign gynecological diseases, so as to provide a reference for applying this cutting-edge technique.

Methods

A retrospective analysis of LESS was conducted. Factors influencing the LESS learning process were assessed using Cox’s proportional hazards regression. The cumulative sum (CUSUM) value and the learning curve were calculated and visualized based on operation time (OT), blood loss (BL), conventional laparoscopic surgery (CLS), conversion rate (CV), and complications (CP). The CUSUM value was defined as the sum of CUSUM_OT, CUSUM_BL, CUSUM_CV, and CUSUM_CP.

Results

A total of 445 cases, including adnexectomies (n = 147), ovarian cystectomies (n = 175), and myomectomies (n = 123) were analyzed. Multivariate regression analysis indicated that adhesion grade (HR, 1.462; 95% CI, 1.016–1.994; p = .045), surgical type (HR, 1.283; 95% CI, 1.042–1.429; p = .024), and surgeon CLS experience (HR, 1.372; 95% CI, 1.097–2.246; p = .012) were independent factors predicting surgeons’ mastery of the LESS technique. Among gynecologists with CLS experience, the cutoff points were 17, 20, and 27 cases for adnexectomy, ovarian cystectomy, and myomectomy, respectively. For those without CLS experience, the corresponding cutoff values were 19, 27, and 35 cases.

Conclusion

The learning curve of LESS for benign gynecological diseases indicates a stepwise process, during which the surgeon’s CLS experience is the key, especially in ovarian cystectomy and myomectomy. For the training of young gynecologists, CLS should be emphasized in the early stage, and LESS should be introduced gradually.

KEYWORDS:

• Laparoendoscopic single-site surgery
• learning curve
• cumulative sum
• benign gynecological diseases
• conventional laparoscopic surgery experience

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data analyzed in this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.