Cumulative Summation Test for Learning Curve in Vaginal Tightening

The objective was to evaluate the learning curve of vaginoplasty procedures performed by two trainees with different levels of experience using the Learning Curve Cumulative Summation (LC-CUSUM) method.

This prospective study included 80 consecutive vaginoplasty cases performed by two trainees after structured theoretical and hands-on training. Trainee 1 was a senior resident in the third year of the Obstetrics and Gynecology specialty training program, with no prior experience in urogynecological surgery, whereas Trainee 2 was a certified specialist with a relevant surgical background. Both trainees were evaluated using LC-CUSUM parameters based on predefined acceptable (10%) and unacceptable (17.5%) failure rates. The number of procedures required to reach competency was recorded.

Trainee 1 reached the predefined performance level after 27 procedures, whereas Trainee 2 achieved it after 14. No major complications occurred. The LC-CUSUM curves confirmed gradual and safe skill acquisition in both cases. Patient satisfaction scores were high in both groups, with no statistically significant differences in complication rates.

The LC-CUSUM method provides an objective and individualized tool to assess surgical competence in vaginoplasty. It enables dynamic monitoring of learning curves and may contribute to safer surgical training, especially in procedures where experience heavily influences outcomes.