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Retroperitoneal Field Development Time as a Procedure-Specific Learning Metric in Transperitoneal Laparoscopic
Naoyuki Ida1, Shoji Nagao1, Yui Tanaka1
1Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Journal of Minimally Invasive Gynecology
|July 1, 2026
Summary
Retroperitoneal field development time stabilizes earlier than total operative time during transperitoneal laparoscopic para-aortic lymphadenectomy (TLPAN) implementation. This metric may indicate early technical skill improvement for surgical teams.
Area of Science:
- Minimally Invasive Surgery
- Surgical Education
- Gynecologic Oncology
Background:
- Transperitoneal laparoscopic para-aortic lymphadenectomy (TLPAN) is a complex procedure.
- Assessing early technical stabilization during TLPAN implementation is crucial for patient safety.
- Team-based learning and standardized training are key to surgical proficiency.
Purpose of the Study:
- To determine if retroperitoneal field development time can serve as a procedure-specific learning metric for TLPAN.
- To evaluate early technical stabilization during the team-based implementation of TLPAN.
- To compare the learning curve of retroperitoneal field development time with overall operative time.
Main Methods:
- Retrospective observational study at a single tertiary academic center.
- Analysis of 46 consecutive endometrial cancer patients undergoing TLPAN.
- Utilized linear regression, CUSUM, risk-adjusted CUSUM, and segmented regression for sequential analysis.
Main Results:
- Retroperitoneal development time showed a trend towards stabilization earlier than total operative time.
- CUSUM analysis indicated a turning point around Case 9-11 for retroperitoneal development.
- A breakpoint in total operative time was identified later, around Case 13.
Conclusions:
- Retroperitoneal field development time may be a valuable early indicator of technical stabilization in TLPAN.
- This metric can aid in assessing surgical team learning curves during procedure implementation.
- Further research is needed to confirm the relationship with cadaver surgical training and case accumulation.
