Learning curve of single-port gasless laparoscopy for gynecological procedures: a cumulative sum analysis of 42 consecutive cases.

OBJECTIVE

To evaluate the learning curve of single-port gasless laparoscopy (SPGL) in gynecological procedures using cumulative sum (CUSUM) analysis and to compare clinical outcomes across distinct learning phases.

METHODS

We retrospectively analyzed 42 consecutive patients who underwent SPGL for gynecological conditions between 2022 and 2025 by a single surgeon at a tertiary hospital. CUSUM analysis was applied to operative time as the primary indicator of technical proficiency. Cases were stratified into four learning phases based on CUSUM inflection points. Kruskal-Wallis tests and Spearman rank correlation were used for statistical comparisons across phases.

RESULTS

CUSUM analysis identified four learning phases: Phase I (cases 1-11, 2022), Phase II (cases 12-22, 2023), Phase III (cases 23-36, 2024), and Phase IV (cases 37-42, 2025). Median operative time decreased significantly from 118 min (IQR 73.5-127.5) in Phase I to 59.5 min (IQR 46.25-104.0) in Phase III (Kruskal-Wallis H = 7.980, p = 0.046). Spearman correlation confirmed a significant negative association between case number and operative time (ρ = -0.427, p = 0.005), blood loss (ρ = -0.344, p = 0.026), and C-reactive protein levels (ρ = -0.323, p = 0.037). No significant differences in hospital stay or pain scores were observed across phases.

CONCLUSION

A surgeon performing SPGL gynecological procedures demonstrates meaningful technical improvement within approximately 22 cases, with further refinement continuing thereafter. SPGL is a safe and feasible technique with an acceptable learning curve comparable to conventional laparoscopic approaches.