Learning curves of a resident surgeon performing transobturator tape procedures for stress urinary incontinence

Abstract

Objective: To evaluate the number of procedures necessary for an untrained resident surgeon to learn transobturator tension-free vaginal tape (TVT-O) procedures for treatment of stress urinary incontinence (SUI).

Methods: A prospective study was performed among patients aged 18-75 years who underwent TVT-O procedures at a center in Rome, Italy, between March 2, 2009, and November 30, 2012. The TVT-O procedure was performed by a right-handed resident surgeon working under the supervision of an expert surgeon. Total and partial operative times were recorded.

Results: Among 18 patients included in analysis, the mean operative time was 22.2minutes (range 7-44). All total operative times fell within the confidence interval after the 10th procedure, with a difference between the mean times recorded in the first nine and the last eight procedures (29.5 vs 13.1minutes; P<0.001). The resident surgeon required nine procedures to learn right tunneling and 13 to learn left tunneling.

Conclusion: Ten procedures were required for a resident surgeon to learn TVT-O procedures for SUI.

Keywords: Learning curve; Midurethral sling; Resident surgeon; Sling placement; Stress urinary incontinence; Transobturator tape; Transobturator tension-free vaginal tape.