Laparoscopic Pectopexy-CUSUM Learning Curve and Perioperative Complications Analysis

Area of Science:

• Urogynecology
• Minimally Invasive Surgery

Background:

• Apical prolapse affects many women, impacting quality of life.
• Laparoscopic pectopexy (LP) is a surgical option for apical prolapse.
• Understanding the learning curve and complications is crucial for surgical adoption.

Purpose of the Study:

• To evaluate the learning curve for laparoscopic pectopexy (LP).
• To assess perioperative complications associated with LP.
• To compare outcomes with and without concomitant laparoscopic supracervical hysterectomy (LSH).

Main Methods:

• Prospective study of 60 women with stage II-IV apical prolapse undergoing LP.
• Patients divided into LSH(+) and LSH(-) groups.
• Learning curve assessed using cumulative sum (CUSUM) and Kwiatkowski-Phillips-Schmidt-Shin (KPSS) tests.
• Complications analyzed using Clavien-Dindo (C-D) classification.

Main Results:

• Mean operative time: 143.5 min; blood loss: 1.5 g/dL; hospital stay: 2.5 days.
• Laparoscopic supracervical hysterectomy (LSH) increased operative time (p=0.01) but not bleeding or hospital stay.
• Severe complications rate was low (1.7%), with one bowel injury in the LSH(-) group.
• Surgeon A achieved steady operative time after 28 procedures; overall proficiency after 38-40 procedures.

Conclusions:

• Laparoscopic pectopexy (LP) demonstrates a feasible learning curve.
• Concomitant LSH does not significantly increase perioperative risks.
• LP is a safe procedure with a low rate of severe complications.