3. Surgical Technique After induction of general anaesthesia, patients selleck chemicals llc 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 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. The peritoneal surface over the sacral promontory was then incised at the base of the sigmoid mesentery and it was carefully dissected down the periosteum to avoid injuring the median sacral vessels.

An endoanal sizer was inserted transvaginally to identify the vaginal cuff and the peritoneum overlying the vaginal apex was similarly incised. The bladder 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 Carfilzomib 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.