经阴道自然腔道内镜手术治疗卵巢囊肿的学习曲线分析：一项回顾性队列研究。
Learning curve analysis of transvaginal natural orifice transluminal endoscopic surgery in treating ovarian cysts: a retrospective cohort study.
机构信息
Department of Gynecology Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, 610091, Sichuan, People's Republic of China.
Department of Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
出版信息
BMC Womens Health. 2024 Jul 25;24(1):424. doi: 10.1186/s12905-024-03261-2.
BACKGROUND
Transvaginal Natural Orifice Transluminal Endoscopy (vNOTES) is regarded as a challenging surgical technique to learn but is promising in reducing perioperative pain and significantly improves the cosmetic outcomes. Previous studies on the learning curve analysis of vNOTES mainly focuses on the hysterectomy approach, while the vNOTES ovarian cystectomy's learning curve was merely reported though more frequently performed than vNOTES hysterectomy. Therefore, this study seeks to analyze the learning curve of three surgeons with varying levels of experience in performing endoscopic surgery and vaginal surgeries for the treatment of ovarian cysts using vNOTES.
METHODS
A total of 127 patients with ovarian cysts of a variety of pathological types were treated by ovarian vNOTES performed by three surgeons of different levels of endoscopic and transvaginal surgical experience. Each surgeon's learning curve was plotted using the Cumulative Sum method and divided into three or four phases of technique learning at the turning point of the learning curve. The sociodemographic and clinical features of patients in each phase were then compared and factors potentially associated with operation time were also screened.
RESULTS
The learning curve was presented in four phases. The operation time (OT) was significantly shorter in phases II (53.66 ± 16.55 min) and IV (54.39 ± 23.45 min) as compared with phases I (68.74 ± 15.85) and III (75.93 ± 30.55) (p < 0.001). More cases of serve pelvic adhesion and endometrioma were assigned in the later phases. The OT of endometriotic cysts had much longer than that of non-endometriotic cysts(62.57 ± 18.64 min vs. 49.88 ± 14.26 min, p = 0.15) The presence of pelvic adhesion [adjusted odds ratio (OR) 7.149 (0.506, 13.792), p = 0.035] and bilateral cyst [adjusted OR 16.996 (2.155, 31.837), p = 0.025], max diameter of cyst[adjusted OR 2.799 (0.174, 5.425), p = 0.037], and individual surgeon [adjusted OR -6.118 (-11.814, -0.423), p = 0.035] were significantly associated with OT.
CONCLUSION
There learning curve of ovarian vNOTES has four phases. ovarian vNOTES could be mastered after performing seven, nine, and 16 cases by surgeons #1, 2 and 3 respectively, in gynecologic endoscopic surgeries.
TRIAL REGISTRATION
ChiCTR2200059282 (Registered on April 28th, 2022).
背景
经阴道自然腔道内镜手术（vNOTES）被认为是一种具有挑战性的手术技术，但它有望减少围手术期疼痛，并显著改善美容效果。之前关于 vNOTES 学习曲线分析的研究主要集中在子宫切除术方法上，而 vNOTES 卵巢囊肿切除术的学习曲线虽然比 vNOTES 子宫切除术更频繁地进行，但仅被报道过。因此，本研究旨在分析三位不同内镜和经阴道手术经验水平的外科医生在治疗卵巢囊肿时使用 vNOTES 的学习曲线。
方法
共有 127 例不同病理类型的卵巢囊肿患者接受了三位不同内镜和经阴道手术经验水平的外科医生进行的经阴道 vNOTES 治疗。每位外科医生的学习曲线均采用累积和法绘制，并在学习曲线的转折点将其分为三个或四个技术学习阶段。然后比较每个阶段患者的社会人口统计学和临床特征，并筛选与手术时间相关的潜在因素。
结果
学习曲线呈现出四个阶段。与阶段 I（68.74±15.85 分钟）和 III（75.93±30.55 分钟）相比，阶段 II（53.66±16.55 分钟）和 IV（54.39±23.45 分钟）的手术时间（OT）明显缩短（p<0.001）。更多的严重盆腔粘连和子宫内膜异位症病例被分配到后期阶段。与非子宫内膜异位性囊肿相比，子宫内膜异位性囊肿的 OT 明显更长（62.57±18.64 分钟比 49.88±14.26 分钟，p=0.15）。盆腔粘连的存在[校正比值比（OR）7.149（0.506，13.792），p=0.035]和双侧囊肿[校正 OR 16.996（2.155，31.837），p=0.025]、囊肿最大直径[校正 OR 2.799（0.174，5.425），p=0.037]和外科医生个体[校正 OR-6.118（-11.814，-0.423），p=0.035]与 OT 显著相关。
结论
卵巢 vNOTES 的学习曲线有四个阶段。在妇科内镜手术中，外科医生 1、2 和 3 分别进行 7、9 和 16 例手术，就可以掌握卵巢 vNOTES 技术。
临床试验注册号
ChiCTR2200059282（于 2022 年 4 月 28 日注册）。
Zotero 插件