This study looks to evaluate the outcomes Tivantinib of RASCP before and after the incorporation of hands-on training for urology and gynecology residents. 2. Materials and Methods Data were extracted from the medical records of all patients who underwent robotic-assisted sacrocolpopexy at the University Hospitals Case Medical Center (UHCMC) between April 2008 and March 2010. The approval of the UHCMC Institutional Review Board was obtained. The following data were extracted from each patient’s medical record: age; stage of prolapse, concomitant procedure(s), intraoperative and postoperative complications, operative time, blood loss, conversion to laparotomy, length of hospital stay, resident hands- on contribution, and followup. Forty-one patients underwent RASCP between December 2008 and March 2010 with one surgeon.

RASCP was performed in the context of surgical repair of complex pelvic organ prolapse and, in some patients, stress urinary incontinence. The first 20 cases (group I) were performed exclusively by the attending surgeon. In the last 21 cases (group II), 2 urology residents at the PGY 5 level performed a 50% or more of the RASCP while 2 gynecology residents at the PGY 4 level performed the supracervical or total hysterectomy when indicated. Prior robotic experience of all surgeons included exposure to didactic and instructional videos encompassing principals of robotic surgeries with video demonstration of a wide variety of gynecologic procedures. Subsequently, a dry laboratory hands-on training with the robotic system was completed.

In addition, robotic surgical skills were also acquired in the animal laboratory using the porcine model. Concomitantly, all surgeons assisted at the operating table in a wide variety of robotic procedures. Finally, all surgeons participation as console surgeon in the procedures was based on a stepwise progression through various aspects of the surgery by performing tasks with variable complexities under the supervision of the attending surgeons for the 4 residents or the supervision of another experienced attending in a minimum of 15 robotic procedures that were considered as a learning curve. 3. Surgical Technique After induction of general anaesthesia, patients were positioned in dorsal lithotomy position with both arms tucked by the side and a bean bag was adjusted to keep the arms and the shoulders in place.

Pneumoperitoneum is usually induced using a Verres needle. A 12mm trocar was placed 2�C5cm supraumbilically. Two 8 mm robotic trocars were placed bilaterally, 10cm lateral to and at the level AV-951 of the umbilicus. An accessory 10mm trocar was placed in the left lower quadrant. Monopolar scissors were inserted through the right robotic trocar and a Plasma kinetic (PK) dissecting forceps was inserted through the left robotic trocar.