title: Why complex pelvic organ prolapse should be repaired vaginally.
abstract: OBJECTIVE
  Vaginal surgery is the true minimally invasive surgery in the treatment of pelvic organ prolapse (POP); however, the robotic industry and decreased resident training in vaginal surgery may result in the loss of skills among our graduates. There are a number of procedures that are well accepted in the management of prolapse, because they are minimally invasive and with few complications compared with the abdominal approach. In this review, we will discuss various vaginal techniques for complex POP. In our opinion, the most minimally invasive approach is vaginal surgery.
  
  
  RESULTS
  There are no recent significant findings on the vaginal approach to complex pelvic organ surgery and mostly case series about success of robotic procedures. There are a significant number of studies exploring the benefits of robotic surgery. It has been observed that the operating times are longer and there is a learning curve. Although there are advantages to robotic surgery, one must not overlook the significant cost associated with obtaining the robot, the maintenance and the cost of disposable instruments. There is limited evidence to show that robotic surgery did not benefit women with benign gynecological disease in terms of effectiveness or safety.
  
  
  CONCLUSIONS
  POP is a vaginal problem, which is best treated vaginally. There are many well designed studies that support the vaginal approach to primary POP.
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans Campus, Department of Obstetrics and Gynecology, Urogynecology Section, Louisiana, USA. rchess@lsuhsc.edu
authors.forename: Ralph
authors.initials: R
authors.lastname: Chesson
authors.forename: Barry
authors.initials: B
authors.lastname: Hallner
mesh_terms: D000071938:Fasciotomy; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014621:Vagina / Q000601:surgery*