title: Is there a learning curve for the TVT-O procedure? A prospective single-surgeon study of 372 consecutive cases.
abstract: OBJECTIVE
  To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™).
  
  
  METHODS
  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.
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. Electronic address: mauserati@hotmail.com.
authors: Maurizio
authors: M
authors: Serati
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Giorgio
authors: G
authors: Bogani
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Andrea
authors: A
authors: Braga
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Paola
authors: P
authors: Sorice
authors: Department of Obstetrics and Gynaecology, Vita-Salute San Raffaele University and IRRCS San Raffaele Hospital, Milan, Italy.
authors: Stefano
authors: S
authors: Salvatore
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Stefano
authors: S
authors: Uccella
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Fabio
authors: F
authors: Ghezzi
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000193:education / Q000592:standards*
keywords: Learning curve; Sling; Stress urinary incontinence (SUI); TVT-O; Urinary incontinence (UI)