Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy
ObjectiveThis study aimed to evaluate the learning curve for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in ovarian cystectomy and to identify perioperative factors influencing operative time.MethodsThis prospective observational study included 39 patients who underwent vNO...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1629418/full |
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| author | Qiang Zhang Wenting Dong Biao Huang Biao Huang Aijie Xie Zhaolin Gong Dan Feng Li He Yonghong Lin |
| author_facet | Qiang Zhang Wenting Dong Biao Huang Biao Huang Aijie Xie Zhaolin Gong Dan Feng Li He Yonghong Lin |
| author_sort | Qiang Zhang |
| collection | DOAJ |
| description | ObjectiveThis study aimed to evaluate the learning curve for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in ovarian cystectomy and to identify perioperative factors influencing operative time.MethodsThis prospective observational study included 39 patients who underwent vNOTES ovarian cystectomy at Chengdu Women’s and Children’s Central Hospital between June 2022 and June 2024. Patients were grouped into two surgical phases based on the operating team’s self-assessed proficiency. Cumulative sum analysis of operative time (CUSUMOT) was used to model the learning curve and define distinct learning stages. Multivariate linear regression was performed to identify independent predictors of operative time.ResultsThe mean patient age was 35.14 ± 9.73 years, and the mean operative time was 74.01 ± 30.09 min. Three cases (7.7%) required intraoperative conversion to transumbilical laparoscopy, and two patients (5.1%) experienced perioperative complications. CUSUMOT analysis revealed four distinct learning phases: learning (9 cases), plateau (10 cases), challenging (12 cases), and mature (8 cases). Operative time during the mature phase was significantly shorter than in earlier phases. Multivariate regression identified pelvic adhesions (β = 6.92, p = 0.027), bilateral cysts (β = 6.38, p = 0.019), cyst diameter (β = 2.85 per cm, p = 0.026), and learning curve phase (β = −17.10 for Phase II, p = 0.035) as independent predictors of operative time.ConclusionvNOTES is a safe and feasible approach for ovarian cystectomy with a measurable learning curve. Proficiency can be achieved after approximately 20 cases. Pelvic adhesions, cyst characteristics, and surgical experience significantly impact operative time. CUSUM analysis is a useful tool for evaluating surgical competency and guiding clinical training in vNOTES procedures. |
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| institution | OA Journals |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj-art-e3e7fae95e8d46f39e53ab43ebc6f1772025-08-20T02:31:27ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.16294181629418Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomyQiang Zhang0Wenting Dong1Biao Huang2Biao Huang3Aijie Xie4Zhaolin Gong5Dan Feng6Li He7Yonghong Lin8Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaSichuan Jinxin Xinnan Women & Children Hospital, Chengdu, ChinaDepartment of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, ChinaNHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing, ChinaDepartment of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaObjectiveThis study aimed to evaluate the learning curve for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in ovarian cystectomy and to identify perioperative factors influencing operative time.MethodsThis prospective observational study included 39 patients who underwent vNOTES ovarian cystectomy at Chengdu Women’s and Children’s Central Hospital between June 2022 and June 2024. Patients were grouped into two surgical phases based on the operating team’s self-assessed proficiency. Cumulative sum analysis of operative time (CUSUMOT) was used to model the learning curve and define distinct learning stages. Multivariate linear regression was performed to identify independent predictors of operative time.ResultsThe mean patient age was 35.14 ± 9.73 years, and the mean operative time was 74.01 ± 30.09 min. Three cases (7.7%) required intraoperative conversion to transumbilical laparoscopy, and two patients (5.1%) experienced perioperative complications. CUSUMOT analysis revealed four distinct learning phases: learning (9 cases), plateau (10 cases), challenging (12 cases), and mature (8 cases). Operative time during the mature phase was significantly shorter than in earlier phases. Multivariate regression identified pelvic adhesions (β = 6.92, p = 0.027), bilateral cysts (β = 6.38, p = 0.019), cyst diameter (β = 2.85 per cm, p = 0.026), and learning curve phase (β = −17.10 for Phase II, p = 0.035) as independent predictors of operative time.ConclusionvNOTES is a safe and feasible approach for ovarian cystectomy with a measurable learning curve. Proficiency can be achieved after approximately 20 cases. Pelvic adhesions, cyst characteristics, and surgical experience significantly impact operative time. CUSUM analysis is a useful tool for evaluating surgical competency and guiding clinical training in vNOTES procedures.https://www.frontiersin.org/articles/10.3389/fmed.2025.1629418/fulltransvaginal natural orifice transluminal endoscopic surgeryovarian cystectomylearning curveCUSUM analysisminimally invasive surgery |
| spellingShingle | Qiang Zhang Wenting Dong Biao Huang Biao Huang Aijie Xie Zhaolin Gong Dan Feng Li He Yonghong Lin Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy Frontiers in Medicine transvaginal natural orifice transluminal endoscopic surgery ovarian cystectomy learning curve CUSUM analysis minimally invasive surgery |
| title | Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| title_full | Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| title_fullStr | Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| title_full_unstemmed | Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| title_short | Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| title_sort | analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy |
| topic | transvaginal natural orifice transluminal endoscopic surgery ovarian cystectomy learning curve CUSUM analysis minimally invasive surgery |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1629418/full |
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