1. Is there a learning curve for the TVT-O procedure? A prospective single-surgeon study of 372 consecutive cases
- Author
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Andrea Braga, Maurizio Serati, Stefano Uccella, Giorgio Bogani, Stefano Salvatore, Fabio Ghezzi, Paola Sorice, Serati, Maurizio, Bogani, Giorgio, Braga, Andrea, Sorice, Paola, Salvatore, Stefano, Uccella, Stefano, and Ghezzi, Fabio
- Subjects
Cure rate ,Urinary Incontinence, Stress ,Blood Loss, Surgical ,Urogenital Surgical Procedure ,Sling ,Surgical ,Medicine ,Prospective Studies ,urinary incontinence (UI) ,TVT-O ,stress urinary incontinence (SUI) ,Blood Lo ,Pain, Postoperative ,Medicine (all) ,Obstetrics and Gynecology ,Middle Aged ,learning curve ,sling ,medicine.anatomical_structure ,Treatment Outcome ,Urinary incontinence (UI) ,Female ,Clinical Competence ,Human ,Transobturator tape ,medicine.medical_specialty ,Stre ,Postoperative pain ,Operative Time ,Pain ,Humans ,Postoperative ,Suburethral Sling ,Adverse effect ,Learning curve ,Aged ,Suburethral Slings ,Groin ,business.industry ,Length of Stay ,Single surgeon ,Urogenital Surgical Procedures ,Surgery ,Prospective Studie ,Urinary Incontinence ,Reproductive Medicine ,Stress urinary incontinence (SUI) ,Observational study ,business - Abstract
Objectives To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™). Study design A prospective observational study was conducted in a tertiary reference center. Consecutive women treated by TVT-O™ performed by one surgeon were included. Data regarding subjective, objective cure rates, and adverse events were collected. Trends, over the number of procedures, were estimated using assay analyses. Number of procedures and variables were interpolating in standard curves using linear lines. Results Three hundred and seventy two procedures were included. Postoperative pain levels decreased with the increase in the level of expertise (pain levels: 1-day: from 6.6 (±3.3) to 4.3 (±3.1); 95%CI: −0.01603 to 0.001235, p =0.04; 2-day: from 5.6 (±4.1) to 3.6 (±3.7); 95%CI: −0.02092 to −0.002497, p =0.01; 12-month: from 0.1 (±0.7) to 0 (±0); 95%CI: −0.001814 to 0.05019, p =0.07). Overall, objective cure rate was achieved in 93.5% of patients. Additionally, 88.2% and 88.7% patients reported "much better" feeling at PGI-I scale and 80% reduction in UDI score, respectively. We observed, that delta ICIQ-sf (from 12 (±8.7) to 14 (±6.0); p =0.04) and delta-UDI (from 91% to 97%; p =0.04) improved over the time. Conclusions TVT-O procedure offers excellent outcomes with high objective and subjective cure rates and low complications rate, even at the beginning of the surgeon's learning curve. However, a high experience of the surgeon could significantly improve the subjective cure rate and could reduce postoperative the groin pain.
- Published
- 2015