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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, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
Study Objective:
To evaluate whether retroperitoneal field development time can serve as a procedure-specific learning metric for early technical stabilization during team-based implementation of transperitoneal laparoscopic para-aortic lymphadenectomy (TLPAN).
Design:
Retrospective observational study.
Setting:
Single tertiary academic center.
Participants:
Forty-six consecutive patients with endometrial cancer who underwent comprehensive laparoscopic surgical staging, including TLPAN, between October 2023 and December 2025.
Interventions:
Standardized TLPAN performed during the institutional implementation period. Cadaver surgical training using a Thiel-embalmed cadaver model was conducted after Case 7 and was considered a contextual educational event.
Measurements And Main Results:
Retroperitoneal development time was the primary procedure-specific metric, whereas total operative time assessed overall procedural stabilization. Sequential analyses included linear regression, CUSUM, risk-adjusted CUSUM, and segmented regression. Retroperitoneal development time showed a nonsignificant downward trend over sequential cases (slope = -0.37 min/case, p = .068). CUSUM identified a turning point at Case 9, and risk-adjusted CUSUM showed a similar inflection at Case 11 after adjustment for age, body mass index, adhesions, and prior abdominal surgery. Segmented regression identified a breakpoint in total operative time at Case 13, suggesting that retroperitoneal field development stabilized before overall operative performance. Lymph node yields were generally maintained across learning phases.
Conclusion:
During team-based implementation of TLPAN, retroperitoneal field development time stabilized before total operative time. This procedure-specific metric may serve as an early measurable indicator of technical stabilization. The temporal relationship with cadaver surgical training is hypothesis-generating and should be interpreted in the context of case accumulation, procedural standardization, and team-based learning.
