Comparison of Long-Term Outcomes of Single-Port Total Hysterectomy and Multiport Total Hysterectomy with Cumulative Sum Analysis and Exponentially Weighted Moving Average Chart = Comparison of Long-Term Outcomes of Single-Port Total Hysterectomy and Multiport Total Hysterectomy with Cumulative Sum Analysis and Exponentially Weighted Moving Average Chart

다국어 초록 (Multilingual Abstract)

Objective: This study aimed to define the initial and post-learning curves of single-port total laparoscopic hysterectomy (TLH) and multiport TLH by evaluating the data of the initial surgical outcome of a single surgeon.
Methods: Comparison between consecutive 325 cases of single-port TLH undertaken between July 2010 and May 2019 and 441 cases of multiport TLH completed between Jan 2005 and Sep 2017 by the same surgeon at Kyungpook National University Hospital and Kyungpook National University Chilgok Hospital. The results of surgical outcomes were analyzed for changes over the case sequence in each group by using the cumulative sum (CUSUM) analysis and exponentially weighted moving average (EWMA) charts.
Results: According to CUSUM analysis, the initial learning curve of single-port TLH (phase 1) was the 127th case and multiport TLH was the 64th case. Additionally, the initial learning curve of a single port takes more than twice as long as the multiport TLH. Phase two (post-learning curve period) of both groups were between the 128th and 208th (n = 80) cases and the 65th and 245th (n = 153) cases, with multiport TLH being 1.9 times longer. The peak CUSUM time of single-port TLH (1180.3 min) was 71.4 min less than that of multiport TLH (1251.7 min). After post-learning curve periods, the multiport TLH group had a period of secondary learning curves with no plateau curve. In phase two (post-learning curve period), the EWMA chart showed a descending slope in both TLH groups. However, the multiport TLH group showed multiple ascending slopes exceeding the EWMA during phase three (plateau period). The operating times, hospital stays, and blood loss were significantly reduced from phase one to phase three of the both TLH groups, but not the operating times in phase three of the multiport TLH group.
Conclusion: Our long-term present study had demonstrated initial learning curve (efficiency) of 127 cases for single-port TLH and 64 cases for multiport TLH. After overcoming the initial learning curve, it was found that single-port TLH was performed easier than multiport TLH.