title: Robotic-assisted sacrocolpopexy: technique and learning curve.
abstract: BACKGROUND
  Laparoscopic sacrocolpopexy (LSCP) offers a minimally invasive approach for treating vaginal vault prolapse. The Da Vinci robotic surgical system may decrease the difficulty of the procedure. The objective of this study was to describe the surgical technique of robotic-assisted sacrocolpopexy (RASCP) and evaluate its feasibility, safety, learning curve, and perioperative complications.
  
  
  METHODS
  Eighty patients underwent RASCP between November 2004 and June 2007. Robotic dissection of the planes between the bladder and vagina anteriorly and between the vagina and rectum posteriorly was performed. A peritoneal incision was made to expose the sacral promontory and extended down to the vaginal apex. A Y-shaped mesh was sutured to the anterior and posterior surfaces of the vagina. The tail end of the mesh was sutured to the sacral promontory. Intracorporeal knot tying was used in all sutures. The peritoneal incision was closed to cover the mesh using a running suture.
  
  
  RESULTS
  Mean operative time was 197.9 [standard deviation (SD) 66.8] min. After completion of the first ten cases, mean operative time decreased by 25.4% [64.3 min, 95% confidence interval (CI) 16.1-112.4 min, p < 0.01]. Two (2.5%) patients had injury to the bladder, one (1.2%) patient had a small bowel injury, and one (1.2%) patient had a ureteric injury. Postoperatively, five (6%) patients developed vaginal mesh erosion, one (1.2%) patient developed a pelvic abscess, and one (1.2%) patient had postoperative ileus. Four (5%) cases were converted to laparotomy. Mean follow-up period was 4.8 months (range 1-24 months).
  
  
  CONCLUSIONS
  RASCP is a feasible procedure with acceptable complication rates and short learning curve.
authors.affiliation: Department of Gynecologic Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Akl.Mohamed@mayo.edu
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Akl
authors.forename: Jaime B
authors.initials: JB
authors.lastname: Long
authors.forename: Dobie L
authors.initials: DL
authors.lastname: Giles
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Cornella
authors.forename: Paul D
authors.initials: PD
authors.lastname: Pettit
authors.forename: Anita H
authors.initials: AH
authors.lastname: Chen
authors.forename: Paul M
authors.initials: PM
authors.lastname: Magtibay
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome