Defining the Learning Curve for Transobturator Tape Surgery: A Prospective LC-CUSUM Study of Surgical Competency Acquisition.

OBJECTIVE: The objective of this study was to apply the Learning Curve-Cumulative Summation (LC-CUSUM) method to objectively evaluate the learning curve and competency acquisition of surgical trainees performing transobturator tape (TOT) surgery for the treatment of stress urinary incontinence (SUI). MATERIALS AND METHODS: This prospective observational study followed two board-certified specialists with no prior experience in mid-urethral sling procedures. A total of 80 consecutive TOT operations (40 per trainee) were analyzed. Before practicing independently, trainees completed a structured three-stage program: a theoretical course, hands-on cadaveric dissection, and individualized mentorship. Surgical performance was monitored using the LC-CUSUM test, with a predefined acceptable failure rate of 5% and an unacceptable rate of 10%. RESULTS: LC-CUSUM analysis showed that the competency threshold was achieved after the 21st procedure for Trainee 1 and after the 11th procedure for Trainee 2. Notably, Trainee 1 operated on patients with a significantly higher mean Body Mass Index (31.8 vs. 27.0 kg/m2), which contributed to longer operative times (84.2 vs. 51.6 min) and a higher rate of de novo urgency (10% vs. 0%). Overall complication rates were low in both groups, and both trainees maintained stable performance once proficiency was reached. CONCLUSION: The learning curve for TOT surgery is relatively short, with competency typically acquired within 11-21 cases. The LC-CUSUM method serves as a robust and individualized tool for monitoring surgical performance, supporting a shift from traditional volume-based requirements to objective, competency-based training models. Structured educational frameworks, including cadaveric training and mentorship, are essential for ensuring patient safety during the skill acquisition phase.