In addition, bladder perforation was encountered in 1 (2%) of patients of group 1. It was recognized and adequately repaired intraoperatively without adverse sequelae. Vaginal wall was accidentally opened in one patient of group 2 due to extremely thin vagina and was sutured with adequate reapproximation. KPT-185 Table 2 Surgical outcomes overall and by group. 6.3. Postoperative Outcomes Postoperative complications are described in Table 2. One patient in group 2 developed postoperative cuff dehiscence and was diagnosed 6 weeks postoperatively during routine postoperative follow-up visit. The vaginal cuff was revisited and adequately sutured under general anesthesia. One patient in group 1 required blood transfusion due to anemia secondary to chronic hemorrhoids in the postoperative period.

Two patients in group 1 and one patient in group 2 were readmitted to the hospital for surgical repair of a vaginal mesh extrusion. Mesh extrusion is defined as any vaginal mesh exposure during the follow up period. All erosions were managed by freshening the edges and closing the vaginal defect. One patient required excision of a portion of the exposed mesh. Vaginal estrogen cream was offered to all patients after surgery. Three patients in group 1 developed postoperative urinary tract infection and were properly treated with antibiotics. Prolapse recurrence was reported in one patient of group 1 where the anterior vaginal wall was prolapsed to the level of the hymen. This patient underwent vaginal McCall culdoplasty. One patient in group 2 was complicated by postoperative ileus diagnosed with a CT scan.

The patient was managed conservatively and showed a significant improvement on day 6 where she was discharged. One patient in group 2 developed postoperative surgical emphysema and pulmonary edema and she was readmitted to surgical intensive care unit (SICU) where she was properly managed and was discharged after 2 days. The mean length of hospital stay was 1.8 days (range 1�C6 days) in both groups. Preoperative POP-Q scores were similar between groups for anterior, apex, gh, pb, and TVL values (Table 3). There was a borderline significant difference (P = 0.057) between posterior (Ap and Bp) scores between groups. On 12-week followup, the POP-Q values were significantly improved after surgery in both groups (Table 3, time effect) with no effect on vaginal length in both groups (P = 0.

99). There was no interaction effect between group and time in POP-Q measurements; however, there was limited ability to detect differences due to small sample sizes. Table 3 Mean preoperative and postoperative POP-Q values by group. 7. Discussion This study demonstrates that the incorporation of resident training does not Carfilzomib appear to affect the immediate operative outcome on performing complex pelvic reconstructive surgery. This is important because the use of robotic-assisted sacrocolpopexy has given patients an alternative treatment to vaginal vault prolapsed [7].