An endoanal sizer was inserted transvaginally to identify the vaginal cuff and the peritoneum overlying the vaginal apex was similarly incised. The bladder blog post was then dissected anteriorly to expose the anterior vaginal wall and the space between the vagina and rectum was dissected in a similar fashion. After completing the dissection, a Y-shaped polypropylene mesh (Restorelle, Mypathy Medical, Raynham, MA) was introduced through the 10mm accessory port. The Monopolar scissors was then changed to a needle driver and the Y-shaped mesh were sutured to the anterior, posterior, and the apex of the vagina using permanent (2�C0 Goretex, W. L. Gore and Associates, Inc., Flagstaff, AZ) sutures. The other end of the mesh was then sutured to the sacral promontory using the same type of permanent suture.

Afer suturing both ends the mesh was then adjusted to avoid redundancy or excessive tension. CystoUrethoscopic examination after administration of intravenous indigo carmine at the end of the procedure to ensure ureteric patency and bladder integrity was performed in all patients. 4. Followup All patients were asked to come for followup at 6 weeks postoperatively. Subsequent followup visits were individualized thereafter. Records were reviewed up to 24 weeks postoperatively. 5. Statistical Analysis Patient demographic and clinical characteristics were described among all cases and compared between group 1 cases (without trainee involvement) and group 2 cases (with trainee involvement) by the use of either the chi-square or Fisher’s exact test for frequency data or nonparametric Mann-Whitney test.

Surgical outcomes were compared between groups in a similar fashion. Preoperative and post-operative POP-Q values were described and comparisons were made between groups by the use of the Mann-Whitney test and analysis of variance. 6. Results 6.1. Patient Characteristics Forty-one patients with stage III/IV prolapse underwent RASCP between December 2008 and March 2010. The first 20 patients were performed exclusively by the attending surgeon (Group I) and the following 21 patients’ surgeries were performed by urology or gynecology residents (group 2). Overall, the mean age was 61.5 (15) years and mean BMI was 28.6 (12.7) kg/m2. Both groups were comparable regarding their age, ethnicity, and BMI. Stage and history of prior prolapse and incontinence surgery were similar between groups.

Eighty-three percent of patients’ surgeries were menopausal. Selected comorbidities were present in 12 patients (9 in group 1 and 3 in group 2; P = 0.033). Patients’ Drug_discovery characteristics were summarized in (Table 1). Table 1 Patient/clinical demographics overall and by group, P value is comparison between groups. 6.2. Intraoperative Outcomes Concomitant procedures were performed in 36 (88%) patients.