{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:00:47Z","timestamp":1787238047442,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to apply the Learning Curve\u2010Cumulative Summation (LC\u2010CUSUM) 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This prospective observational study followed two board\u2010certified specialists with no prior experience in mid\u2010urethral sling procedures. A total of 80 consecutive TOT operations (40 per trainee) were analyzed. Before practicing independently, trainees completed a structured three\u2010stage program: a theoretical course, hands\u2010on cadaveric dissection, and individualized mentorship. Surgical performance was monitored using the LC\u2010CUSUM test, with a predefined acceptable failure rate of 5% and an unacceptable rate of 10%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LC\u2010CUSUM 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\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), which contributed to longer operative times (84.2 vs. 51.6\u2009min) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The learning curve for TOT surgery is relatively short, with competency typically acquired within 11\u221221 cases. The LC\u2010CUSUM method serves as a robust and individualized tool for monitoring surgical performance, supporting a shift from traditional volume\u2010based requirements to objective, competency\u2010based training models. Structured educational frameworks, including cadaveric training and mentorship, are essential for ensuring patient safety during the skill acquisition phase.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70416","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T10:12:57Z","timestamp":1787220777000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Defining the Learning Curve for Transobturator Tape Surgery: A Prospective LC\u2010CUSUM Study of Surgical Competency Acquisition"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5517-8461","authenticated-orcid":false,"given":"Yasin","family":"Ceylan","sequence":"first","affiliation":[{"name":"Private Practice in Obstetrics and Gynecology Mugla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0332-496X","authenticated-orcid":false,"given":"\u00d6zlem","family":"Y\u00fcksel Aybek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Ba\u011fc\u0131lar Training and Research Hospital Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2080-2471","authenticated-orcid":false,"given":"Ay\u015fe","family":"Demirden","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Ba\u011fc\u0131lar Training and Research Hospital Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6799-5909","authenticated-orcid":false,"given":"Eray","family":"\u00c7al\u0131\u015fkan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Okan University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04171-w"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01902378"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/SPV.0b013e3182495885","article-title":"Vaginal Placement of Synthetic Mesh for Pelvic Organ Prolapse","volume":"18","author":"Practice, C. on G","year":"2012","journal-title":"Female Pelvic Medicine and Reconstructive Surgery"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-11039-5"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1002\/bjs.6056","article-title":"Quantitative and Individualized Assessment of the Learning Curve Using LC\u2010CUSUM","volume":"95","author":"Biau D. J.","year":"2008","journal-title":"British Journal of Surgery"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2009.01.133"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dep391"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-025-06495-2"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.4274\/anajog.galenos.2025.69885"},{"issue":"6","key":"e_1_2_10_11_1","first-page":"1306","article-title":"Transobturator Urethral Suspension: Mini\u2010Invasive Procedure in the Treatment of Stress Urinary Incontinence in Women","volume":"11","author":"Delorme E.","year":"2001","journal-title":"Progres en Urologie"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12894-015-0060-3","article-title":"Meta\u2010Analysis of Female Stress Urinary Incontinence Treatments with Adjustable Single Incision Mini\u2010Slings and Transobturator Tension Free Vaginal Tape Surgeries","volume":"15","author":"Zhang P.","year":"2015","journal-title":"BMC Urology"},{"issue":"3","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/uog.5270","article-title":"CUSUM: A Tool for Ongoing Assessment of Performance","volume":"31","author":"Biau D. 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