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Abstract：
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.
CONCLUSIONS: 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.
BACKGROUND: ChiCTR2200059282 (Registered on April 28th, 2022).
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.
CONCLUSIONS: 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.
BACKGROUND: ChiCTR2200059282 (Registered on April 28th, 2022).
摘要：
背景：经阴道自然口腔内内窥镜检查（vNOTES）被认为是一项具有挑战性的手术技术，但在减轻围手术期疼痛和显着改善美容效果方面具有广阔的前景。以前关于vNOTES学习曲线分析的研究主要集中在子宫切除术的方法上，虽然vNOTES卵巢囊肿切除术的学习曲线仅被报道，但比vNOTES子宫切除术更频繁。因此,本研究旨在分析3名外科医生在使用vNOTES治疗卵巢囊肿时进行内窥镜手术和阴道手术经验不同的学习曲线.
方法：共127例各种病理类型的卵巢囊肿患者，由3位不同级别的内镜及经阴道手术经验的外科医生进行卵巢vNOTES治疗。使用累积和方法绘制每个外科医生的学习曲线，并在学习曲线的转折点处分为三个或四个阶段的技术学习。然后比较每个阶段患者的社会人口统计学和临床特征，并筛选与手术时间潜在相关的因素。
结果：学习曲线分为四个阶段。与I期（68.74±15.85）和III期（75.93±30.55）相比，II期（53.66±16.55分钟）和IV期（54.39±23.45分钟）的手术时间（OT）明显缩短（p<0.001）。在后期分配了更多的盆腔粘连和子宫内膜瘤病例。子宫内膜异位囊肿的OT比非子宫内膜异位囊肿的OT长得多（62.57±18.64minvs.49.88±14.26分钟,p=0.15）骨盆粘连的存在[调整后的比值比（OR）7.149（0.506，13.792），p=0.035]和双侧囊肿[校正OR16.996(2.155,31.837)，p=0.025],囊肿的最大直径[调整OR2.799（0.174，5.425），p=0.037],和个别外科医生[调整后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。卵巢vNOTES可以在执行七个后掌握，九,和16例分别由外科医生＃1，2和3，在妇科内窥镜手术中。
背景：ChiCTR2200059282（4月28日注册，2022年）。
方法：共127例各种病理类型的卵巢囊肿患者，由3位不同级别的内镜及经阴道手术经验的外科医生进行卵巢vNOTES治疗。使用累积和方法绘制每个外科医生的学习曲线，并在学习曲线的转折点处分为三个或四个阶段的技术学习。然后比较每个阶段患者的社会人口统计学和临床特征，并筛选与手术时间潜在相关的因素。
结果：学习曲线分为四个阶段。与I期（68.74±15.85）和III期（75.93±30.55）相比，II期（53.66±16.55分钟）和IV期（54.39±23.45分钟）的手术时间（OT）明显缩短（p<0.001）。在后期分配了更多的盆腔粘连和子宫内膜瘤病例。子宫内膜异位囊肿的OT比非子宫内膜异位囊肿的OT长得多（62.57±18.64minvs.49.88±14.26分钟,p=0.15）骨盆粘连的存在[调整后的比值比（OR）7.149（0.506，13.792），p=0.035]和双侧囊肿[校正OR16.996(2.155,31.837)，p=0.025],囊肿的最大直径[调整OR2.799（0.174，5.425），p=0.037],和个别外科医生[调整后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。卵巢vNOTES可以在执行七个后掌握，九,和16例分别由外科医生＃1，2和3，在妇科内窥镜手术中。
背景：ChiCTR2200059282（4月28日注册，2022年）。
