The learning curve of laparoscopic single-site total hysterectomy with conventional laparoscopic instruments

Total hysterectomy is a relatively intricate surgical procedure in clinical practice. Laparoscopic total hysterectomy has become widely adopted in clinical settings. With the clinical advancement of single-port technology, single-port laparoscopy (SL) has garnered extensive popularity due to its safety and aesthetic appeal. This method involves entering the abdominal cavity through a single incision at the umbilicus, offering benefits such as minimal trauma, rapid recovery, and improved cosmesis. However, the high operational complexity results in a longer learning curve. This study retrospectively analyzed cases of laparoscopic total hysterectomy performed at the First People's Hospital of Xiaoshan District, Hangzhou City, from January 2020 to October 2024. The analysis included 50 cases, with 25 conducted via SL and 25 via conventional 3-port laparoscopy (CL). Various parameters were collected, including body mass index, uterine size, operative duration, changes in hemoglobin levels, leukocyte levels, neutrophil levels, C-reactive protein levels, and patient fever incidence. The cumulative sum (CUSUM) technique was employed for learning curve analysis to assess surgical proficiency. CUSUM analysis is a statistical method to monitor cumulative deviations from a target value, was used to objectively quantify the learning process by tracking operative time trends across sequential cases. This study showed that there were no statistically significant differences in the baseline characteristics and postoperative changes between the 2 groups. CUSUM analysis revealed a proficiency threshold at 12 cases, after which SL operative time (123 ± 15 min) matched CL (118 ± 14 min; P = .32). In total hysterectomy procedures, once proficiency is achieved, SL can yield safety outcomes comparable to those of CL. These findings provide valuable guidance for gynecologists interested in adopting SL. As technology continues to evolve and experience accumulates, SL is poised to offer patients an increasing array of minimally invasive treatment options.