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Importance: Proper training is necessary to develop the highly specialized skills required to safely perform laparoscopic sacrocolpopexy. Currently, there is no validated training model for laparoscopic sacrocolpopexy that includes dissection of the presacral space, both vaginal and presacral mesh attachments, and peritoneal closure., Objectives: This study aimed to create a procedure specific hierarchical task analysis for laparoscopic sacrocolpopexy and then develop and validate a corresponding laparoscopic sacrocolpopexy pelvic training model for the simulation environment., Study Design: This was an observational simulation study that was divided into 5 phases: (1) development of hierarchical task analysis, (2) model construction, (3) participant recruitment and simulation testing, (4) reliability and validity testing, and (5) creation of a standard passing performance measure., Results: Construct, face, and content validity were established for this model. According to the participating experts, the model was able to replicate the steps of presacral dissection, anterior vaginal and sacral mesh attachment, and peritoneal closure. Thirteen trainees and 5 experts completed the simulation, and all "agreed" or "strongly agreed" that the model seemed useful for improving suturing technique and learning the procedure. Additionally, a passing performance measure was determined through contrasting groups methodology., Conclusions: We developed a novel, reusable, and validated training model that can be utilized as a training resource for the many critical skills necessary to safely and efficiently perform laparoscopic sacrocolpopexy., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Importance: There is limited literature or even consensus on the suture material used for posterior vaginal repairs., Objectives: This study aimed to compare outcomes of barbed versus nonbarbed delayed absorbable suture used for posterior colporrhaphy., Study Design: This study conducted a randomized controlled trial of 72 women undergoing posterior repair using standardized technique-concurrent procedures permitted with barbed (n = 36) or nonbarbed (n = 36) suture. Standardized examinations, validated questionnaires, and a visual analog scale (VAS) were completed at baseline, 6 weeks, and 12 months, and a telephone interview was conducted at 6 months. The primary outcome was posterior compartment pain at 6 weeks, measured by a VAS., Results: Seventy-two women enrolled, with follow-up rates 6 weeks (100%), 6 months (90.3%), and 12 months (73.6%). Demographics were similar between groups. A VAS with movement was not different between groups at 6 weeks. The odds of experiencing vaginal pain, having myofascial pain on examination, or being sexually active postoperatively were not different between the groups. There were no differences in the length of posterior colporrhaphy, surgical times, or hospital length of stay between the groups. Suture passes were lower in the nonbarbed group (median, 4 vs 7; P = <0.001), and suture burden was higher in the nonbarbed group (median, 26.9 vs 10.5 cm; P = <0.001). There was overall improvement in Pelvic Floor Distress Inventory Short Form 20 prolapse and colorectal subscores but no differences between groups. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form 12 scores improved, and dyspareunia decreased at 6 and 12 months in both groups. In addition, there were few anatomic recurrences at 6 weeks (0%) and 12 months (3.4%) and few adverse events., Conclusions: This study found no differences in primary or secondary outcomes; however, both suture types resulted in clinical improvements in quality-of-life measures and sexual function., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

To describe an obstetrics and gynecology residency robotic curriculum, facilitated by a web-based feedback and case-tracking tool, allowing for self-selection into advanced training. Phase I (Basic) was required for all residents and included online training modules, online assessment, and robotic bedside assistant dry lab. Phase II (Advanced) was elective console training. Before live surgery, 10 simulation drills completed to proficiency were required. A web-based tool was used for surgical feedback and case-tracking. Online assessments, drill reports, objective GEARS assessments, subjective feedback, and case-logs were reviewed (7/2018-6/2019). A satisfaction survey was reviewed. Twenty four residents completed Phase I training and 10 completed Phase II. To reach simulation proficiency, residents spent a median of 4.1 h performing required simulation drills (median of 10 (3, 26) attempts per drill) before live surgery. 128 post-surgical feedback entries were completed after performance as bedside assistant (75%, n = 96) and console surgeon (5.5%, n = 7). The most common procedure was hysterectomy 111/193 (58%). Resident console surgeons performed portions of 32 cases with a mean console time of 34.6 ± 19.5 min. Mean GEARS score 20.6 ± 3.7 (n = 28). Mean non-technical feedback results: communication (4.2 ± 0.8, n = 61), workload management (3.9 ± 0.9, n = 54), team skills (4.3 ± 0.8, n = 60). Residents completing > 50% of case assessed as "apprentice" 38.5% or "competent" 23% (n = 13). After curriculum change, 100% of surveyed attendings considered residents prepared for live surgical training, vs 17% (n = 6) prior to curriculum change [survey response rate 27/44 (61%)]. Attendings and residents were satisfied with curriculum; 95% and recommended continued use 90% (n = 19).This two-phase robotic curriculum allows residents to self-select into advanced training, alleviating many challenges of graduated robotic training., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Importance: This study further supports virtual visits for gynecologic preoperative care., Objectives: The objective of this study was to determine if preoperative video visits are noninferior to in-person visits in pelvic reconstructive surgery. Secondary objectives are as follows: patient satisfaction, convenience, visit duration, total perioperative visits, and patient travel time/distance., Study Design: Noninferiority randomized-controlled trial of patients undergoing pelvic reconstructive surgery randomized to in-person or video counseling. The primary outcome was a composite score on the Preoperative Preparedness Questionnaire., Results: Demographics were similar except for higher body mass index (BMI) in the video group (29.5 vs 26.3; P = 0.01), and fewer patients in the video group used text messaging for health care delivery (40.7% vs 59.3%, P = 0.04). Video visits were noninferior to in-person visits in Preoperative Preparedness Questionnaire scores (62.5 ± 4.6 vs 63.0 ± 3.6; difference = 0.5; 95% confidence interval, -0.8, □). There was no difference in "strongly agree" response to question 11, "Overall, I feel prepared for my upcoming surgery" (79.6% vs 88.9%, P = 0.19). Satisfaction was higher for video visits based on composite Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey scores (31.3 ± 1.5 vs 30.5 ± 2, P = 0.02). Video visits were more convenient (100% vs 85.2%, P < 0.01), of shorter duration for patients (39.3 ± 14.0 minutes vs 55.9 ± 18.9 minutes; P < 0.01), and similar length for health care providers (28.8 ± 9.6 minutes vs 28.2 ± 9.8 minutes; P = 0.77). The video visit group had fewer office visits (2.0 vs 3.0, P < 0.01) and traveled 66 minutes ( P < 0.01) and 28 miles ( P < 0.01) less., Conclusion: Preoperative video visits are noninferior to in-person visits for preparing patients for pelvic reconstructive surgery., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Objective: We sought to validate a simulation model for robotic sacrocolpopexy (RSCP) that includes multiple steps: presacral dissection/mesh attachment, vaginal mesh attachment, and peritoneal closure., Methods: An RSCP training model was developed. Female pelvic medicine and reconstructive surgery (FPMRS) experts and current FPMRS fellows were videotaped using the model; sessions were timed and scored using the Global Evaluative Assessment of Robotic Skills (GEARS) by 3 surgeon reviewers masked to participants' identities. Construct validity was measured by comparing performance on the model between experts and trainees. Interrater reliability was determined by calculating intraclass correlation coefficients for total GEARS scores. Face validity was assessed by a postprocedure questionnaire., Results: Experts included 9 board-certified FPMRS physicians experienced in RSCP; trainees were 17 fellows. Experts practiced at 7 different institutions in the United States, and the majority (5/7) taught fellows. Trainees were from 7 institutions and in various years of training: postgraduate year (PGY) 5 (n = 6), PGY 6 (n = 5), and PGY 7 (n = 6). Experts' performances were rated significantly higher for total GEARS scores and for relevant domains of the GEARS scale. Intraclass correlation coefficient for the 3 reviewer pairs (0.96-0.99) indicated high interrater reliability. All participants "agreed/strongly agreed" that the model closely approximated live RSCP surgery and was useful for teaching and learning the procedure, indicating high face validity., Conclusions: This novel, multistep simulation model demonstrated construct validity and high interrater reliability. Face validity was also established. Consequently, this RSCP model could be used for surgical training and assessment of these discrete surgical skill steps., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Objectives: To evaluate the effect of vaginal intraoperative infiltration of liposomal bupivacaine on vaginal pain among patients undergoing posterior colporrhaphy and perineorrhaphy., Methods: This was a randomized, placebo-controlled trial offered to women undergoing posterior colporrhaphy and perineorrhaphy with concomitant pelvic reconstructive procedures. Liposomal bupivacaine or normal saline placebo (30 mL) was injected into the posterior vaginal compartment and perineal body in 2- to 3-mL increments, using a systematic technique. All participants received 10-mL 0.25% bupivacaine with epinephrine prior to incision. Perioperative care was standardized. The primary outcome was vaginal pain as measured by a visual analog scale., Results: One hundred twenty-six women were screened, and 72 were included. Demographic characteristics were similar. Median visual analog scale was not different at any time point (P = 0.81). There were no differences in secondary outcomes, including narcotic use (37.5 vs 37.5 mg morphine equivalents, P = 0.51; placebo vs liposomal bupivacaine), time to first opioid (68 vs 89.5 minutes, P = 0.56), antiemetic doses (3 vs 2, P = 0.07), hospital length of stay (24 vs 21.9 hours, P = 0.98), length of stay in postanesthesia care unit (93 vs 100 minutes, P = 0.32), proportion of patients who had a bowel movement within the first 3 postoperative days (65.7 vs 59.5% P = 0.36), or successful voiding trials (45.7 vs 59.5%, P = 0.24). There were no differences in patient satisfaction or postoperative adverse events., Conclusions: In this study of pelvic reconstructive surgeries with posterior colporrhaphy and perineorrhaphy, there were no differences in pain scores or any secondary outcomes between liposomal bupivacaine and placebo injected into the posterior vaginal compartment., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Objectives: The objectives of this study were to describe a cadaveric simulation model designed to teach sacrospinous ligament fixation (SSLF) and to assess trainee performance, comfort, and skill with suture placement., Methods: Nine invited participants from 3 institutions participated in cadaveric simulation training, consisting of a didactic lecture, technical demonstrations, and supervised execution of suture placement. Trainee self-perceived knowledge and confidence levels of SSLF were assessed before and after the educational intervention. Suture placement was assessed by expert faculty pelvic reconstructive surgeons. The number of attempts required by trainees for an anatomically safe suture placement was recorded. Participants completed a postintervention satisfaction survey., Results: All 9 participants correctly identified where an SSLF suture should be placed on a printed image before the educational intervention, but only 33% achieved anatomically safe suture placement on the first attempt (mean ± SD, 2.88 ± 2.10 attempts). Four participants (44%) reported comfort with independently performing SSLF before the course. Of these, three (75%) required more than 1 attempt for successful suture placement. Mean ± SD distance of SSLF suture from the ischial spine was 1.90 ± 0.59 cm. All participants reported that they found the training helpful in learning the surgical steps and anatomy related to SSLF and would recommend it to others., Conclusions: A cadaveric simulation teaching model led to improved trainee-reported confidence with the operative steps and anatomy related to SSLF. Participants' prior knowledge of procedural steps and anatomy did not always transfer to adequate procedural skills for safe suture placement, suggesting the need for further simulation practice for fellow trainees., Competing Interests: The authors have declared they have no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The objective of this study was to evaluate if twice-daily nitrofurantoin for 5 days after discontinuation of transurethral catheterization decreases the rate of urinary tract infection (UTI) in women with postoperative urinary retention (POUR) after pelvic reconstructive surgery., Methods: This was a double-blind, placebo-controlled, randomized trial conducted across 2 clinical sites between October 2017 and April 2019. Women with acute POUR after pelvic reconstructive surgery were included and randomized to nitrofurantoin (100 mg) or placebo twice-daily for 5 days. The primary outcome was clinically suspected UTI (defined as dysuria, frequency, and irritation in the absence of vaginal discharge) and/or culture-proven UTI (defined as greater than 105 colony forming units of a single organism) within 30 days of surgery. Secondary outcomes included evaluation of adverse events related to study medication and medication adherence., Results: Data from 164 participants were eligible for intention-to-treat analysis (nitrofurantoin, n = 82; placebo, n = 82). There were no significant demographic or intraoperative differences except for body mass index and race. Median duration of catheterization was 3 days (interquartile range, 2-5 days, P = 0.12). Fifteen women in the nitrofurantoin group and 14 women in the placebo group experienced UTI within 30 days (18.3% vs 17.1%; P = 0.84; odds ratio, 1.09; 95% confidence interval, 0.49-2.43). There were no study medication allergies; however, nausea was the most common intolerance. Most women in each group completed the study drug treatment (91.5% vs 86.4%, P = 0.30)., Conclusions: Nitrofurantoin prophylaxis after transurethral catheter removal did not reduce the risk of UTI in women with acute POUR after pelvic reconstructive surgery., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Objectives: The primary objective was to compare levels of satisfaction, regret, and Patient Global Impression of Improvement (PGI-I) scores between women who underwent vaginal uterosacral ligament suspension (USLS) and minimally invasive sacrocolpopexy (SCP). Secondary objectives were to identify which preoperative counseling resources were most useful., Methods: This was a multicenter, retrospective cohort study through the Fellows' Pelvic Research Network that included women who underwent a USLS or SCP between January 2013 and January 2016 with 1-year follow-up. Women completed the Decision Regret Scale for Pelvic Floor Disorders, Satisfaction with Decision Scale for Pelvic Floor Disorders, and PGI-I. Data were also collected on usefulness of various educational preoperative resources., Results: A total of 175/367 (47.6%) women participated; 45 (25.7%) and 130 (74.3%) in the USLS and SCP groups, respectively. Mean Decision Scale for Pelvic Floor Disorders scores were 4.6 ± 0.8 and 4.5 ± 0.7 (P = 0.30) in the USLS and SCP groups, respectively, indicating a high level of satisfaction with surgical decision. The mean Decision Regret Scale for Pelvic Floor Disorders score was 1.5 ± 0.8 in USLS and 1.6 ± 0.8 in SCP (P = 0.53). The SCP group had higher PGI-I scores (1.7 ± 1.4 vs 2.0 ± 1.3, P = 0.02), indicating lower perceived postoperative improvement. Most women (151 [86.3%] of 175) reported that verbal counseling was sufficient and would not have found additional resources helpful., Conclusions: Women have high satisfaction and low regret with their decision to pursue surgical correction with USLS or SCP. Most are satisfied with only verbal preoperative counseling., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2019 American Urogynecologic Society. All rights reserved.)

Objectives: The primary objective was to evaluate 1-year anterior wall anatomic success rates for vaginal uterosacral ligament suspension (USLS) and minimally invasive sacral colpopexy (SCP) using delayed-absorbable suture. Secondary objectives included assessment of apical success, mesh or suture exposure, and postoperative quality of life (QoL) measures 12 months after surgery., Methods: This was a retrospective cohort study including women who underwent a hysterectomy with concomitant USLS or SCP with delayed-absorbable suture from January 2011 to December 2015 with 1-year follow-up. Successful anterior vaginal wall support was defined as Ba of less than 0. Successful apical support was defined as no apical descent (point C) greater than one half of the total vaginal length. In addition, 1-year QoL questionnaires were measured postoperatively., Results: A total of 282 women were identified. Sixty-two women (31 vaginal USLS and 31 SCP) met inclusion criteria. Demographics were similar between groups except for a higher body mass index in the USLS group (27.5 ± 5.6 kg/m vs 24.1 ± 3.3 kg/m, P < 0.05). Preoperative POP-Q was mostly stage II and III. At 1-year, anatomic success rates for the anterior compartment were 66.7% versus 90.3% for USLS and SCP groups, respectively (P = 0.02). There was no significant difference in apical success (P = 1.00) or QoL scores between groups at 1 year., Conclusions: Anatomic success rates at 1 year using delayed-absorbable suture were better for SCP when using the anterior wall as a measure of success, but there were no significant differences in apical success rates, mesh or suture exposure, and QoL measures between groups.

Background: There are limited robotic dry lab training resources that include presacral dissection with vaginal and sacral mesh attachment for robotic sacrocolpopexy. Our objective was to create a simulation model to resemble the anatomy encountered during robotic sacrocolpopexy. Additionally, we sought to outline the steps required to complete a robotic sacrocolpopexy by performing a hierarchical task analysis. With the results of the hierarchical task analysis, we assessed the model's ability to provide an adequate platform for completion of robotic sacrocolpopexy procedural steps., Method: This observational simulation study was divided into two phases. Phase 1 included model development. Phase 2 involved development of the hierarchical task analysis and assessment of the model., Experience: After model creation, six experts each performed a robotic sacrocolpopexy using the model. Overall, experts agreed that the model replicated opening the peritoneum, presacral dissection, suturing on the anterior and posterior vagina, and presacral mesh attachment., Conclusion: We demonstrate construction and use of a robotic sacrocolpopexy simulation model to aid surgeons in training. Further, the hierarchical task analysis provides a method to assess the model's ability to replicate each step of robotic sacrocolpopexy.

The Robotic Objective Structured Assessment of Technical Skills (R-OSATS) is a previously validated assessment tool that is used to assess 5 standardized inanimate robotic surgery drills. R-OSATS is used to evaluate performance on surgical drills, with scores of 0 to 20 for each drill. Our objective was to establish the minimum threshold score that denotes competence on these drills. Thus, we performed a standard setting study using data from surgeons and trainees in 8 academic medical centers. Cutoff scores for the minimal level of competence using R-OSATS were established using 2 techniques: the modified Angoff and the contrasting groups methods. For the modified Angoff method, 8 content experts met and, in an iterative process, derived the scores that a minimally competent trainee should receive. After 2 iterative rounds of scoring and discussion with the modified Angoff method, we established a minimum competence score per drill with high agreement (rWG range, 0.92-0.98). There was unanimous consensus that a trainee needs to achieve competence on each independent drill. A second method, the contrasting groups method, was used to verify our results. In this method, we compared R-OSATS scores from "inexperienced" (34 postgraduate year 1 and 2 trainees) with "experienced" (22 faculty and fellow) robotic surgeons. The distributions of scores from both groups were plotted, and a cutoff score for each drill was determined from the intersection of the 2 curves. Using this method, the minimum score for competence would be 14 per drill, which is slightly more stringent but confirms the results obtained from the modified Angoff approach. In conclusion, using 2 well-described standard setting techniques, we have established minimum benchmarks designating trainee competence for 5 dry lab robotic surgery drills., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)

Introduction: Sacrocolpopexy is one of the most effective surgeries to correct pelvic organ prolapse. Previous studies have described complications, such as mesh erosion and dyspareunia. However, there are few studies on the development of pelvic pain in the absence of mesh erosion in patients who have undergone sacrocolpopexy., Case Reports: We describe 3 patients who presented with apical vaginal pain in the absence of mesh erosion remote from sacrocolpopexy. All patients were refractory to conservative therapies and underwent abdominal excision of mesh with improvement of symptoms postoperatively., Conclusions: The development of de novo pain in the absence of mesh erosion after sacrocolpopexy is an uncommon event but in our cases required complete excision for relief of symptoms. Further research will be needed to understand if surgical technique or materials may be related to the development of symptoms.

Background: Extraosseous Ewing sarcoma (ES) tumors presenting in the genitourinary tract are highly uncommon. Few cases of primary vulvar and vaginal cases of ES have been published., Case: A 15-year-old adolescent presented with a bothersome 5-cm mass located on her left labium minorum. Following excision, a diagnosis of a primary ES was made. The patient was treated with multiagent chemotherapy and was doing well 20 months after treatment completion., Summary and Conclusion: Based on the few available case reports and our reported case, it appears that extraosseous ES arising in superficial sites such as the vulva have better prognosis and should be treated with complete excision and multiagent chemotherapy., (Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Study Objective: To compare resident, fellow, and attending urologic and gynecologic surgeons' musculoskeletal and mental strain during laparoscopic and robotic sacrocolpopexy., Design: Prospective cohort study (Canadian Task Force classification II-2)., Setting: Academic medical center., Patients: Patients who underwent robotic or laparoscopic sacrocolpopexy from October 2009 to January 2011., Interventions: The Body Part Discomfort (BPD) survey was completed before cases, and the National Aeronautics and Space Administration Task Load Index and BPD survey were completed after cases. Higher scores on BPD and the National Aeronautics and Space Administration Task Load Index indicate greater musculoskeletal discomfort and mental strain. BPD scores were averaged over the following body regions: head/neck, back, hand/wrist, arms, and knees/ankles/feet. Changes in body region-specific discomfort scores were the primary outcomes., Measurements and Main Results: Multivariable analysis was performed using mixed-effects linear regression with surgeon as a random effect. Sixteen surgeons participated (53% fellows, 34% residents, and 13% attendings). Thirty-three robotic and 53 laparoscopic cases were analyzed, with a median surgical time of 231 minutes (interquartile range, 204-293 minutes) versus 227 minutes (interquartile range, 203-272 minutes; p = .31), a median estimated blood loss of 100 mL (interquartile range, 50-175 mL) versus 150 mL (interquartile range, 50-200 mL; p = .22), and a mean patient body mass index of 27 ± 4 versus 26 ± 4 kg/m(2) (p = .26), respectively. Robotic surgeries were associated with lower neck/shoulder (-0.19 [interquartile range, -0.32 to -0.01], T = -2.49) and back discomfort scores (-0.35 [interquartile range, -0.58 to 0], T = -2.38) than laparoscopic surgeries. Knee/ankle/foot and arm discomfort increased with case length (0.18 [interquartile range, 0.02-0.3], T = 2.81) and (0.07 [interquartile range, 0.01-0.14], p = .03), respectively., Conclusion: Surgeons performing minimally invasive sacrocolpopexy experienced less neck, shoulder, and back discomfort when surgery was performed robotically., (Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.)

Study Objective: The goal of this study was to determine if a robotic dry laboratory curriculum for gynecology and urology residents improved their basic robotic skills., Methods: After the institution-specific institutional review board approval or exemption, 165 residents from 8 gynecology and/or urology programs were enrolled. Residents underwent standardized robotic orientation followed by dry laboratory testing on 4 unique robotic tasks. Residents were block randomized by program to unstructured or structured training programs. Regardless of group, residents were expected to practice for 15 minutes twice monthly over 7 months. Errors, time to completion, and objective structured assessment of technical skills global rating scores were recorded for each task before and after the training period. Statistics were calculated using the Student t tests, Pearson correlation, and analysis of variance with STATA systems (version 11.2)., Results: A total of 99 residents completed both the pretraining and posttraining testing. A mean of 4 (range, 0-15) 15-minute training sessions per resident was self-reported. The structured group had faster posttraining times on the transection task, although the unstructured group had higher posttraining scores on the knot-tying task., Conclusions: Overall, the residents' robotic skills improved after participating in a dry laboratory curriculum; however, robotic availability, duty hour restrictions, and clinical responsibilities limit the curriculum implementation.

Objective: Objective Structured Assessments of Technical Skills have been developed to measure the skill of surgical trainees. Our aim was to develop an Objective Structured Assessments of Technical Skills specifically for trainees learning robotic surgery., Methods: This is a multiinstitutional study conducted in eight academic training programs. We created an assessment form to evaluate robotic surgical skill through five inanimate exercises. Gynecology, general surgery, and urology residents, Fellows, and faculty completed five robotic exercises on a standard training model. Study sessions were recorded and randomly assigned to three blinded judges who scored performance using the assessment form. Construct validity was evaluated by comparing scores between participants with different levels of surgical experience; interrater and intrarater reliability were also assessed., Results: We evaluated 83 residents, nine Fellows, and 13 faculty totaling 105 participants; 88 (84%) were from gynecology. Our assessment form demonstrated construct validity with faculty and Fellows performing significantly better than residents (mean scores 89±8 faculty, 74±17 Fellows, 59±22 residents; P<.01). In addition, participants with more robotic console experience scored significantly higher than those with fewer prior console surgeries (P<.01). Robotic Objective Structured Assessments of Technical Skills demonstrated good interrater reliability across all five drills (mean Cronbach's α 0.79±0.02). Intrarater reliability was also high (mean Spearman's correlation 0.91±0.11)., Conclusion: We developed a valid and reliable assessment form for robotic surgical skill. When paired with standardized robotic skill drills, this form may be useful to distinguish between levels of trainee performance., Level of Evidence: II.

Uterovaginal prolapse, vaginal vault prolapse, and rectal prolapse are pelvic floor support problems that have been traditionally addressed through abdominal, vaginal or perineal approaches. Over the past decade, minimally invasive approaches to these procedures have been reported and refined. We discuss both laparoscopic and robotic techniques for repair of uterovaginal prolapse, vaginal vault prolapse, and rectal prolapse. In addition, we summarize currently available success and complication data associated with each technique.

Introduction and Hypothesis: We aimed to determine patient recall of specific surgical risks and benefits discussed during consent for midurethral sling (MUS) surgery immediately after consent and at 6 weeks follow-up. Specifically we sought to determine whether or not women recalled specific risks related to the placement of mesh., Methods: Surgeons consented patients for MUS in their usual fashion during audio recorded consent sessions. After consent and again at 6 weeks postoperatively, women completed a checklist of risks, benefits, alternatives, and general procedural items covered during consent. In addition, women completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Audio files were used to verify specific risks, benefits, alternatives, and procedural items discussed at consent. Recall of specific risks, benefits, and alternatives were correlated with DRS-PFD scores., Results: Sixty-three women completed checklists immediately post consent and at 6 weeks postoperatively. Six-week recall of benefits, alternatives, and description of the operation did not change. Surgical risk recall as measured by the patient checklist deteriorated from 92 % immediately post consent to 72 % at 6 weeks postoperatively (p < .001). Recall of the risk for mesh erosion declined from 91 to 64 % (p < .001). Recall that mesh was placed during the MUS procedure declined from 98 to 84 % (p = .01). DRS-PFD scores were correlated with poorer surgical risk recall and surgical complications (r = .31, p = .02)., Conclusions: Recall of MUS surgery risks deteriorated over time. Specifically, women forgot that mesh was placed or might erode. Further investigations into methods and measures of adequate consent that promote recall of long-term surgical risks are needed.

Objectives: To describe perioperative bowel habits of women undergoing gynecologic surgery., Methods: This prospective cohort study included women undergoing gynecologic surgery. Before surgery, participants completed the Bristol Stool Form Scale (BSFS), a validated instrument describing stool characteristics consistent with transit categories: slow (BSFS 1-2), normal (BSFS 3-5), and fast (BSFS 6-7). For 2 weeks after surgery, the participants recorded daily medications and bowel movements (BM), and completed BSFS. The χ(2) test, the Fisher exact test, analysis of variance, t tests, and ordinal regression were used., Results: Preoperatively, most (70%) of 340 women had normal stool transit, with 15% having slow transit and 7% having fast transit. Complete postoperative data were available for 170 (50%). Mean ± SD time to first postoperative BM was 2.8 ± 1.4 days with transit classification: 48% normal, 32% slow, and 20% fast., Conclusions: Most women had normal stool transit both preoperatively and postoperatively. Time to first BM was longer after open surgery by approximately 3 days.

Adolescent women possess physiologic and, frequently, behavioral characteristics that place them at an increased risk for contracting sexually transmitted infections. Diagnosis and prompt treatment of sexually transmitted infections is of paramount importance for an adolescent's future fertility and prevention of transmission to future partners. Diagnosis and treatment is often hindered by lack of symptoms, concern for screening and treatment confidentiality, and lack of knowledge about community medical resources.