More recently, the Da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) has provided the features needed to make the minimally invasive sacrocolpopexies successful [6]. The robot offers three-dimensional vision, increased magnification, tremor filtering, Tubacin HDAC and seven degrees of freedom with its instruments that make a robotic-assisted sacrocolpopexy less difficult than using a traditional laparoscope. The technical aspects of a RASCP reflect those of an abdominal sacrocolpopexy [7]. As the RASCP becomes more widely adopted into practice, the importance of training the next generation of practitioners becomes apparent without neglecting gaining experience in the traditional abdominal and vaginal hysterectomy concomitant with sacrocolpopexy [8].

Robotic surgery credentials are now required in certain places and in the near future it will be required more widely [9]. The training of residents and fellows on the technique of RASCP is important in both urology [10] and gynecology [11]. Balancing education and patient care is central in any surgery, and careful attention to primum non nocere is essential [12]. This study looks to evaluate the outcomes 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. Drug_discovery 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.