Department of Obstetrics and Gynecology, National Taiwan University Hospital , Hsin-Chu Branch, Hsin-Chu, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan.
Sci Rep. 2022 Apr 29;12(1):7025. doi: 10.1038/s41598-022-11039-5.
Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. The study is based on two individual surgeons who performed vaginal pelvic reconstructive surgery with or without mesh. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeons A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32-33 vaginal pelvic reconstructive surgery procedures without mesh and 37-47 procedures in the same surgery with mesh. The total surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. More procedures were needed for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the proficiency boundary, the surgical success rate and operation time were improved.
回顾性分析了 2004 年至 2018 年间连续接受阴道盆底重建手术（伴或不伴网片）的女性，以确定阴道盆底重建手术的学习曲线。通过手术失败和手术时间的累积和（CUSUM）分析，我们评估了阴道盆底重建手术（包括骶棘韧带固定术、前阴道修补术、后阴道修补术和伴或不伴网片的选择性阴道子宫切除术）的学习曲线。该研究基于两位单独的外科医生，他们进行了伴或不伴网片的阴道盆底重建手术。264 名 III 期或 IV 期盆腔器官脱垂女性接受了 A 或 B 外科医生的阴道盆底重建手术。44 个月的中位随访时间范围为 24 至 120 个月。在不使用网片的 32-33 次阴道盆底重建手术中达到了手术熟练程度，在相同手术中使用网片的 37-47 次手术中达到了手术熟练程度。A 和 B 外科医生的总手术成功率分别为 82.2%和 94.1%，中位随访时间分别为 60 和 33 个月。对于有网片的阴道盆底重建手术，需要更多的手术来达到学习曲线。越过熟练边界后，手术成功率和手术时间得到了提高。
