Laparoscopic ultrasound eXAmination: Analysis of fellow surgeons learning curve in minimally invasive gynecologic...

Laparoscopic ultrasound (LUS), performed with an endoscopic ultrasound probe, has shown potential in addressing challenges related to haptic perception and lesion detection in minimally invasive surgery. The aim of the present study was to evaluate the learning curve of gynecologic surgery fellows in achieving competency in LUS image acquisition during minimally invasive procedures.

This prospective single-center study included six gynecologic fellows with limited ultrasound experience who completed a one-day structured training program. Fellows performed laparoscopic ultrasound during elective surgeries for benign conditions and early-stage gynecologic cancers, assessing five anatomical sites. Competency was evaluated using learning curve cumulative summation (LC-CUSUM) analysis based on image quality and examination time. Learning curve time and quality score for each surgeon and anatomical site were measured.

A total of 56 patients and examinations were analyzed. All fellows achieved competency within 2-5 procedures, with LC-CUSUM showing rapid and sustained skill acquisition. Ovarian imaging required fewer attempts than myometrial wall and iliac vessel imaging, with the right external iliac vessels being the most challenging. Patient characteristics did not differ among fellows.

After targeted training, gynecologic surgery fellows can achieve proficiency in LUS within a short learning curve. These findings support the feasibility of integrating LUS training into gynecologic surgical education and highlight its potential to enhance surgical precision and to reduce surgical overall time.