title: Introduction of laparoscopic sacral colpopexy to a fellowship training program.
abstract: OBJECTIVE
  Minimally invasive sacral colpopexy has increased over the past decade, with many senior physicians adopting this new skill set. However, skill acquisition at an academic institution in the presence of postgraduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies, and it also defines a surgical learning curve.
  
  
  METHODS
  The first 180 laparoscopic sacral colpopexies done by four attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher's exact test compared surgical complications and counts of categorical variables.
  
  
  RESULTS
  Mean total operative time was 250 ± 52 min (range 146-452) with hysterectomy and 222 ± 45 (range 146-353) for sacral colpopexy alone. When compared with the first ten cases performed by each surgeon, operative times in subsequent groups decreased significantly, with a 6-16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p = 0.262).
  
  
  CONCLUSIONS
  Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. Reduction in operative time is similar to published learning curves in teaching and nonteaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired.
authors.affiliation: Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, gerschultzkl@upmc.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kantartzis
authors.forename: Gary
authors.initials: G
authors.lastname: Sutkin
authors.forename: Dan
authors.initials: D
authors.lastname: Winger
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shepherd
mesh_terms: D000368:Aged; D004502:Education, Medical, Continuing; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies
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