Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Neurourol Urodyn. 2013 Sep;32(7):964-7. doi: 10.1002/nau.22375. Epub 2013 Jan 28.
The concept of the "learning curve" is a term that has become increasingly prevalent in medical literature. Using a unique Female Urology fellowship program running over the last 3 years, we set out to better define the learning process for mid-urethral slings.
We examined surgical outcomes for six urology trainees who participated in the 6-month program from 2006 to 2011. We identified all retropubic mid-urethral sling procedures they had performed. Demographics included age, BMI, and smoking status. Outcomes focused on complication rates, as well as a subjective patient assessment. Analysis was by the cumulative sum method.
Six trainees performed 187 retropubic slings during their fellowships. Mean age was 54 (SD ± 12.7), mean BMI was 29.5 (SD ± 5.5). One hundred sixty-five (88%) patients only underwent a mid-urethral tape with 22 (12%) undergoing a concomitant procedure. There were 5 cases of bladder perforation, 1 case of urethral injury, 25 cases of voiding dysfunction, and 8 cases of mesh exposure. One hundred sixty-seven out of 180 patients reported a cure or improvement. All complications occurred in the first 4 months of training. CUSUM analysis of voiding dysfunction showed that four out of six trainees did not reach the expected incidence of voiding dysfunction within the completed fellowship. Bladder perforation showed a similar trend.
CUSUM analysis is an underused tool for the analysis of surgical competence. The learning curve for retropubic sling surgery is variable and may be longer than is often acknowledged. We suggest the focus of surgical training should move away from absolute numbers to look at training in an individualized manner.
“学习曲线”的概念在医学文献中越来越流行。我们利用一个独特的女性泌尿科研究员项目，该项目在过去 3 年中运行，旨在更好地定义中尿道吊带的学习过程。
我们检查了 2006 年至 2011 年期间参加为期 6 个月项目的 6 名泌尿科受训者的手术结果。我们确定了他们所进行的所有经耻骨后中尿道吊带术。人口统计学数据包括年龄、BMI 和吸烟状况。结果集中在并发症发生率以及患者的主观评估上。分析采用累积和法。
六名受训者在研究员期间共进行了 187 例经耻骨后吊带术。平均年龄为 54 岁（标准差 ± 12.7），平均 BMI 为 29.5 岁（标准差 ± 5.5）。165 例（88%）患者仅接受中尿道吊带术，22 例（12%）患者同时接受手术。有 5 例膀胱穿孔，1 例尿道损伤，25 例排尿功能障碍，8 例网片暴露。180 例患者中有 167 例报告治愈或改善。所有并发症均发生在培训的前 4 个月。排尿功能障碍的 CUSUM 分析显示，6 名受训者中有 4 名在完成研究员培训期间未达到预期的排尿功能障碍发生率。膀胱穿孔也呈现出类似的趋势。
CUSUM 分析是一种用于分析手术能力的未被充分利用的工具。经耻骨后吊带手术的学习曲线是可变的，可能比通常承认的要长。我们建议将手术培训的重点从绝对数字转移到以个体为基础的培训上。
