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Related Experiment Video

Updated: Apr 30, 2026

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators
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Learning curve for fetoscopic laser surgery using cumulative sum analysis.

Suzanne H P Peeters1, Erik W Van Zwet, Dick Oepkes

  • 1Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.

Acta Obstetricia Et Gynecologica Scandinavica
|April 30, 2014
PubMed
Summary

Surgeons performing fetoscopic laser surgery for twin-to-twin transfusion syndrome reached competence after approximately 25 procedures. Cumulative sum analysis effectively monitors operator performance and ensures quality control in this complex fetal therapy.

Keywords:
Fetofetal transfusioncumulative sum analysislaser therapylearning curveoperator experiencesurvival

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Area of Science:

  • Fetal Medicine
  • Surgical Innovation
  • Medical Education

Background:

  • Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic pregnancies.
  • Fetoscopic laser surgery is a critical intervention for managing TTTS.
  • Monitoring surgeon proficiency is essential for optimal patient outcomes.

Purpose of the Study:

  • To establish a learning curve for fetoscopic laser surgery in TTTS.
  • To evaluate operator performance using cumulative sum (CUSUM) analysis.
  • To assess the effectiveness of CUSUM for quality control in fetal surgery.

Main Methods:

  • Retrospective cohort study of 340 TTTS cases treated between 2000-2010.
  • Learning curve cumulative sum (LC-CUSUM) analysis applied to track double survival rates.
  • Individual operator performance monitored against CUSUM control boundaries.

Main Results:

  • Overall survival of both twins was 59% (201/340) at 4 weeks post-procedure.
  • Operators achieved competence after a median of 25-26 procedures.
  • Learning curve progression was influenced by annual procedure volume and prior invasive experience.

Conclusions:

  • All surgeons attained proficiency in fetoscopic laser surgery for TTTS after at least 25 procedures.
  • Cumulative sum analysis is a valuable tool for assessing learning curves and maintaining quality control.
  • Continuous monitoring using CUSUM can identify performance deviations and ensure consistent surgical expertise.