title: Minimally invasive apical sacropexy:  a retrospective review of laparoscopic and robotic operating room experiences.
abstract: OBJECTIVE
  Minimally invasive apical sacropexies (MI-APSC) can be performed using robotics or laparoscopy. We hypothesized that operative characteristics of MI-APSC, laparoscopic (LSC) and robotic (RSC), were similar. The objective of our study was to compare operative characteristics, objective prolapse outcomes, and robotic learning curve.
  
  
  METHODS
  Ninety-two women planning MI-APSC for treatment of apical pelvic organ prolapse from 2006 to 2010 were included in the study. The primary outcome was operative time. The secondary outcomes included estimated blood loss, rate of conversion, intraoperative complications, hospital stay, and objective prolapse outcome. We also analyzed the robotic learning curve. Statistical analysis included independent samples t test, Wilcoxon rank sum test, χ, and multiple logistic regressions; significance was set at P < 0.05. Learning curve was graphed with moving average and analyzed with moving block technique.
  
  
  RESULTS
  Forty-eight RSCs and 43 LSCs were analyzed. Mean operative times were LSC, 238 ± 59 minutes; and RSC, 242 ± 54 minutes. Robotic MI-APSC setup was longer (P = 0.02). Complications, conversions, estimated blood loss and hospital stay were low and similar between groups. Patients' characteristics were similar. Concomitant procedures produced longer operative times.
  
  
  CONCLUSIONS
  Operating room experiences with laparoscopic- and robotic-assisted approaches to MI-APSC were similar, but setup time is longer for the robotic-assisted approach. The robotic learning curve is short for surgeons who have experience with LSC.
authors.affiliation: Department of Vincent Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Pulliam
authors.forename: Milena M
authors.initials: MM
authors.lastname: Weinstein
authors.forename: May M
authors.initials: MM
authors.lastname: Wakamatsu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D059032:Learning Curve; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D012371:Robotics / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology*; D016896:Treatment Outcome