title: Transvaginal cholecystectomy learning curve.
abstract: BACKGROUND
  There are few surgeons in the United States, within private practice and academic centers, currently performing transvaginal cholecystectomies (TVC). The lack of exposure to TVC during residency or fellowship training, coupled with a poorly defined learning curve, further limits interested surgeons who want to apply this technique to their practice. This study describes the learning curve encountered during the introduction of TVC to our academic facility.
  
  
  METHODS
  This study is an analysis of consecutive TVCs performed between August 14, 2009 and August 3, 2012 at an academic center. The TVC patients were divided into sequential quartiles (n = 15/16). The learning curve outcome was measured as the operative time of TVC patients and compared to the operative time of female laparoscopic cholecystectomy (LC) patients performed during the same time period.
  
  
  RESULTS
  Sixty-one patients underwent a TVC with a mean age of 38 ± 12 years and mean BMI was 29 ± 6 kg/m(2). Sixty-seven female patients who underwent a LC with average age 41 ± 15 years and average BMI 33 ± 12 kg/m(2). The average operative time of LC patients and TVC patients was 48 ± 20 and 60 ± 17 min, respectively. Significant improvement in TVC operative times was seen between the first (n = 15 TVCs) and second quartiles (p = 0.04) and stayed relatively constant for third quartile, during which there was no statistically significant difference between the mean LC operative time for the second and third TVC quartiles
  
  
  CONCLUSIONS
  The learning curve of a fellowship-trained surgeon introducing TVC to their surgical repertoire, as measured by improved operative times, can be achieved with approximately 15 cases.
authors.affiliation: Department of Surgery, Yale School of Medicine, 40 Temple St., Suite 7B, New Haven, CT, 06510, USA, stephanie.wood@yale.edu.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Wood
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.forename: Susan
authors.initials: S
authors.lastname: Dabu-Bondoc
authors.forename: Hosni
authors.initials: H
authors.lastname: Mikhael
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
authors.forename: Andrew
authors.initials: A
authors.lastname: Duffy
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
mesh_terms: D000328:Adult; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D059032:Learning Curve; D061646:Operative Time