Evidence map›Paper›PMID 40584704›Full record

ArticleFrontiers in medicine2025

Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy.

Qiang Zhang, Wenting Dong, Biao Huang, Aijie Xie, Zhaolin Gong, Dan Feng, Li He, Yonghong Lin

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Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Qiang Zhang *Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Wenting Dong *Sichuan Jinxin Xinnan Women & Children Hospital, Chengdu, China.
Biao Huang *Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Aijie XieDepartment of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Zhaolin GongDepartment of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Dan FengDepartment of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Li HeDepartment of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Yonghong LinDepartment of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: This study aimed to evaluate the learning curve for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in ovarian cystectomy and to identify perioperative factors influencing operative time. Methods: This prospective observational study included 39 patients who underwent vNOTES ovarian cystectomy at Chengdu Women's and Children's Central Hospital between June 2022 and June 2024. Patients were grouped into two surgical phases based on the operating team's self-assessed proficiency. Cumulative sum analysis of operative time (CUSUMOT) was used to model the learning curve and define distinct learning stages. Multivariate linear regression was performed to identify independent predictors of operative time. Results: The mean patient age was 35.14 ± 9.73 years, and the mean operative time was 74.01 ± 30.09 min. Three cases (7.7%) required intraoperative conversion to transumbilical laparoscopy, and two patients (5.1%) experienced perioperative complications. CUSUMOT analysis revealed four distinct learning phases: learning (9 cases), plateau (10 cases), challenging (12 cases), and mature (8 cases). Operative time during the mature phase was significantly shorter than in earlier phases. Multivariate regression identified pelvic adhesions ( Conclusion: vNOTES is a safe and feasible approach for ovarian cystectomy with a measurable learning curve. Proficiency can be achieved after approximately 20 cases. Pelvic adhesions, cyst characteristics, and surgical experience significantly impact operative time. CUSUM analysis is a useful tool for evaluating surgical competency and guiding clinical training in vNOTES procedures.

Indexed as

CUSUM analysislearning curveminimally invasive surgeryovarian cystectomytransvaginal natural orifice transluminal endoscopic surgery

Identifiers

PMID40584704
PMCPMC12202431

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.