Batuhan ÜSTÜN, Erhan Hüseyin CÖMERT, Gaye ARSLAN
Anatolian Journal of Obstetrics and Gynecology Research - 2025;2(3):106-110
Purpose: To assess and compare the learning curves of linear and wedge labiaplasty performed by trainees with no prior cosmetic gynecology experience using the Learning Curve-Cumulative Summation (LC-CUSUM) method. Methods: This retrospective study analyzed the first 40 consecutive cases performed by two obstetrician-gynecologist trainees. Trainee 1 performed linear labiaplasty , and Trainee 2 performed wedge labiaplasty . Both trainees had completed a structured two-day training course. Unfavorable outcomes were defined as wound dehiscence, postoperative infection requiring antibiotics, or esthetic dissatisfaction where both surgeon and the patient agree on a revision. The acceptable failure rate (p0) was set at 3% and the unacceptable rate (p1) at 10%, with alpha=0.05 and beta=0.20. LC-CUSUM curves were constructed using standard algorithms to identify the point at which each trainee achieved competence (decision limit h=2.5). Results: Patient demographics did not differ significantly between the two groups. Operative time was significantly longer for wedge labiaplasty (98+/-20 min) compared with linear labiaplasty (74+/-22 min, p<0.01). The overall unfavorable outcome rate was 2.5% for linear and 12.5% for wedge labiaplasty (p=0.08). LC-CUSUM analysis indicated that competence was achieved after the eighth case for linear labiaplasty and the thiteenth case for wedge labiaplasty . Both trainees' performance curves remained below the decision limit, suggesting acceptable performance after these thresholds were reached. Conclusion: The LC-CUSUM test demonstrated that linear labiaplasty requires a shorter learning curve compared with wedge labiaplasty in trainees new to cosmetic gynecology . The wedge technique, while esthetically advantageous, is technically more demanding and associated with a higher early complication rate and longer operative time. These results provide evidence-based guidance for training programs, suggesting that linear labiaplasty should be introduced first in structured cosmetic gynecology curricula. Adoption of LC-CUSUM-based monitoring may enhance patient safety and standardize competence assessment in aesthetic gynecologic surgery .
