Chapter 6 130 156 controls having a primary procedure both with a minimum follow-up of 12 months. We did not observe differences in subjective and objective success rates, nor in graft related complications and reinterventions for complications, or recurrence. Therefore, we concluded that in our experience, redo LSCP is safe and effective. LSCP requires dissection and suturing skills, both leading to long operation times. One possibility to cut on operation time is to substitute sutures by synthetic glue for mesh fixation. We performed a cost-minimization analysis of laparoscopic sacrocolpo(-recto)pexy using synthetic glue or only sutures in two consecutive cohorts (n=20). Although the use of synthetic glue for mesh fixation increased consumable costs, the procedure time decreased significantly, overall resulting in a 14% reduction of the procedure cost. Workflow analysis is a tool that can assist in defining and overcome the learning curve of a given operation, and suggest bottle necks and potential modifications to overcome these. In collaboration with the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK we found that benchmark AI models for this purpose, shown successful in cholecystectomy and cataracts, failed in laparoscopic sacrocolpopexy procedures, due to its large phase durations and variability. Therefore, we re-designed the AI model from scratch to overcome these bottle necks and improve both the accuracy and computation time of the analysis. We will further refine this novel approach in ongoing work. In conclusion, we demonstrated that though vaginal laser application improves POP and SUI symptoms as much as PFE do and without adverse events, their treatment effect was short lasting. In terms of surgical treatment of UI in the presence of POP, we did not implement cervicosacropexy or vaginosacropexy, because of the lack of robust early evidence. We reviewed our outcomes of sacrocolpopexy following the introduction of lightweight mesh, demonstrating a reduction in number of graft related complications without compromising subjective and objective outcomes. We also demonstrated the safety and efficacy of redo sacrocolpopexy. We further demonstrated that operation times of sacrocolpopexy could be reduced by using synthetic glue without increasing hospital costs. Finally, a validated automatized workflow analysis of this intervention will further help us to investigate and optimize surgical skills and assess the impact of procedural changes.
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