Use of the Learning Curve-Cumulative Summation test for quantitative and individualized assessment of competency of a surgical procedure in obstetrics and gynecology: fetoscopic laser ablation as a model

作者：Papanna Ramesha^*; Biau David J; Mann Lovepreet K; Johnson Anthony; Moise Kenneth J Jr

来源：American Journal of Obstetrics and Gynecology, 2011, 204(3): 218.e1.

DOI：10.1016/j.ajog.2010.10.910

• formal training
• laser photocoagulation
• learning curve-cumulative summation
• twin-twin transfusion syndrome

OBJECTIVE: We sought to determine the learning curve (LC) for fetoscopic laser photocoagulation (FLP) as a model for the evaluation of training in surgical procedures.
STUDY DESIGN: A retrospective review of consecutive case series of FLP from 2 centers with 3 operators (operator I [O-I], observer trained; operator II [O-II], hands-on trained; and operator III [O-III], clinical fellow) was performed and the LC-cumulative summation (CUSUM) test was plotted.
RESULTS: The acceptable and unacceptable success rates for at least 1 fetus survival after FLP were set at 82% and 70%, respectively, from a systematic review. A total of 171 consecutive cases were performed by the 3 operators (O-I, 91; O-II, 49; and O-III, 31). From LC-CUSUM test O-I needed 60 procedures, O-II needed 20 procedures, and O-III needed 20 procedures to reach an acceptable performance rate for at least 1 survivor.
CONCLUSION: The LC-CUSUM test can be used to accurately assess the LC in a surgical procedure in obstetrics and gynecology. Hands-on trained operators exhibit a shorter LC.

• 出版日期2011-3