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Patel JS, Cyrus JW, Siff LN. Surgical education in urogynecology from low fidelity to virtual reality: Systematic review. Neurourol Urodyn 2023; 42:1777-1788. [PMID: 37522524 DOI: 10.1002/nau.25257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
IMPORTANCE Increase dissemination of educational tools in urogynecology. OBJECTIVE Describe the effectiveness and public availability of published educational tools for urogynecologic surgery. STUDY DESIGN A systematic review was conducted by searching MEDLINE, EMBASE, Cochrane Library, and Web of Science from 1946 to 2023 for articles describing educational tools in urogynecology. There were no restrictions on study design or language. Data were extracted in duplicate using a standardized piloted extraction form, and outcomes were combined descriptively. RESULTS 2997 titles, 457 abstracts, and 97 full-text articles were analyzed. Of the 97 interventions included, 43 were manuscripts and 54 were conference abstracts. The median study quality was low, with a moderate risk of bias. Six intervention categories were identified: didactics, animal models, cadavers, static models, extended reality (XR), and multimodal workshops. Didactics were subjectively useful for teaching pelvic anatomy and diseases and improving surgical techniques. If good quality, animal models and cadavers provided visual and tactile learning and assessed performance in real-time. Animal models were also anatomically realistic and useful at half the cost of cadavers. Static models and XR improved confidence, knowledge, skills, and error rates despite lack of realism and accurate tissue texture in some models and steep learning curve with XR. Only four models were commercially accessible. Most studies did not assess long-term (>6 months) retention. CONCLUSION All educational modalities for urogynecologic surgery are largely realistic and increase participant satisfaction, preparedness, knowledge, skills, and likelihood of use. But only 40% advanced to manuscripts, and even fewer (<5%) were widely available.
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Affiliation(s)
- Jill S Patel
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John W Cyrus
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Lauren N Siff
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Division of Surgical Gynecology and Urogyncecology, Department of Surgery, Central Virginia VA Healthcare System, Richmond, Virginia, USA
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Dällenbach P. Laparoscopic Lateral Suspension (LLS) for the Treatment of Apical Prolapse: A New Gold Standard? Front Surg 2022; 9:898392. [PMID: 36034345 PMCID: PMC9406280 DOI: 10.3389/fsurg.2022.898392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Nowadays, the gold standard to treat apical pelvic organ prolapse (POP) is laparoscopic sacrocolpopexy (LSCP). However, LSCP is a difficult procedure associated with rare but potentially severe complications. Promontory dissection may expose to potential life-threatening intraoperative vascular injuries, and sacral roots or hypogastric nerve damage. There are also a few case reports of spondylodiscitis with consecutive lumbar vertebra bone erosion. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical POP repair. It lowers perioperative risks by avoiding sacral promontory preparation. Recent studies show similar anatomical and functional outcomes to LSCP, with the advantage of better preserving the vaginal axis. Moreover, LLS is well suited for hysteropexy which is important as an increasing number of women prefer uterine preservation during POP surgery. In this article, we discuss both techniques, and we share our opinion on a novel perspective in the treatment of apical POP with uterine preservation.
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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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Development of a Low-Fidelity Laparoscopic Sacrocolpopexy Simulation Model and Evaluation of Curriculum. Female Pelvic Med Reconstr Surg 2021; 27:474-480. [PMID: 34027910 DOI: 10.1097/spv.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Minimally invasive sacrocolpopexy (SCP) is a compelling surgical procedure that requires advanced laparoscopic suturing and dissection skills and knowledge of pelvic retroperitoneal anatomy. The aim of this study was to develop a low-cost laparoscopic SCP model and educational curriculum to improve dissection and suturing skills along with anatomic knowledge to avoid complications. METHODS The pelvic SCP model was developed with easily available material that was placed on the commercial pelvic bone model to construct a vagina, major vessels, ureter, peritoneum, and areolar tissue. A comprehensive curriculum encompassing didactic and technical skills components on the pelvic model was used to teach laparoscopic SCP. Participants completed precurriculum and postcurriculum multiple-choice questionnaires to evaluate the didactic component. A modified Objective Structured Assessment of Technical Skills (OSATS) tool was used to measure technical skills before and after technical skills curriculum. RESULTS Among the 10 senior residents, 6 (60%) were studying at their fourth postgraduate year, and 3 (30%) were studying at their third postgraduate year. Postcurriculum test scores (14.5 vs 10.6) for assessment of cognitive knowledge were significantly improved (P < 0.001). The median postcurriculum OSATS scores (26.5; range, 18-30) were significantly improved (P = 0.005). Laparoscopic SCP OSATS scores increased from median 21 to median 26.5 after cognitive and technical curriculum, showing a 21.4% improvement. The majority (70%) of residents believed that the SCP model would be useful to enhance skills acquisition before performing the skill in the operating room. CONCLUSIONS A low-fidelity laparoscopic SCP curriculum showed improvement in cognitive knowledge and technical skills.
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Laparoscopic Pectopexy-CUSUM Learning Curve and Perioperative Complications Analysis. J Clin Med 2021; 10:jcm10051052. [PMID: 33806294 PMCID: PMC7961615 DOI: 10.3390/jcm10051052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
The study aimed to examine the learning curve and perioperative complications for laparoscopic pectopexy (LP). A total of 60 women with stage II–IV apical prolapse who underwent LP were dichotomized into groups: LSH(+) with concomitant laparoscopic supracervical hysterectomy (LSH), LSH(−) after previous supracervical/total hysterectomy. Operative time, estimated blood loss and hospitalization length were evaluated with cumulative sum (CUSUM) analysis and the Kwiatkowski–Phillips–Schmidt–Shin (KPSS) test, separately for two surgeons (A and B). Intraoperative and perioperative complications according to the Clavien–Dindo (C–D) classification were analyzed. Mean operative time, change in hemoglobin level, and postoperative hospital stay were 143.5 ± 23.1 min—1.5 ± 0.5g/dL and 2.5 ± 0.9 days, respectively. LSH during pectopexy was associated with longer operative time (p = 0.01) but not with higher intraoperative bleeding or prolonged hospital stay. Severe complications rate was low (1.7%) with one bowel injury in LSH(−) (C–D grade IIIb). No C–D grade II, IV and V complications were found. Conversion to open pectopexy, return to the operating room or blood transfusion were not required. The KPSS test showed that a steady operative time for Surgeon A was achieved after 28 procedures. A proficiency for laparoscopic pectopexy based on CUSUM analysis was observed after 38–40 procedures.
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Ruiz-Hernández M, López-Fando L, Sánchez-Guerrero C, Sánchez-González Á, Artiles-Medina A, Santiago-González M, Jiménez-Cidre MÁ, Burgos-Revilla FJ. Combined laparoscopic surgery for the treatment of pelvic organ prolapse and recurrent urinary incontinence. Actas Urol Esp 2021; 45:160-166. [PMID: 33308857 DOI: 10.1016/j.acuro.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/06/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for apical pelvic organ prolapse (POP). Artificial urinary sphincter (AUS) has a high success rate in treating recurrent stress urinary incontinence (SUI). OBJECTIVE To describe the first simultaneous LSC and AUS implantation through a vesicovaginal approach to the bladder neck. MATERIAL AND METHODS Operation is performed through a transperitoneal approach. The rectovaginal space is created and the posterior mesh is fixed. The vesicovaginal and both laterovesical spaces are dissected. The vesicovaginal space is connected to both lateral spaces. This is main step of the procedure because it let us place the cuff around the bladder neck in a non-blind fashion. The anterior mesh is fixed to the vagina. The anterior side of the bladder neck is dissected and the cuff implanted. Both meshes are fixed to the promontory. Pressure-regulating balloon is inserted, the pump is placed in the labia majora and the components are connected. Peritoneum is closed. RESULTS Surgical time was 180 minutes, bladder catheter was removed at 5th postoperative day, hospital stay was 5 days. The AUS was activated 6 weeks after surgery. No perioperative complications occurred. After 12 months the patient is pad-free and prolapse was objectively and subjectively cured. CONCLUSIONS Vesicovaginal dissection is a shared step in this technique of LSC and AUS implantation. This approach could minimize the risk of bladder neck injury. We propose this technique in selected cases of prolapse and recurrent SUI.
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Affiliation(s)
- M Ruiz-Hernández
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España.
| | - L López-Fando
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Sánchez-Guerrero
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - Á Sánchez-González
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Artiles-Medina
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - M Á Jiménez-Cidre
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Burgos-Revilla
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
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Soler-Silva Á, Sanchís-López A, Sánchez-Guillén L, López-Rodríguez-Arias F, Gómez-Pérez L, Quirós MJA, Sánchez-Ferrer ML, Escoriza JCM, Muñoz-Duyos A, Ramírez JM, Arroyo A. The Thiel cadaveric model for pelvic floor surgery: Best rated in transferable simulation-based training for postgraduate studies. Eur J Obstet Gynecol Reprod Biol 2020; 256:165-171. [PMID: 33248374 DOI: 10.1016/j.ejogrb.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether the Thiel cadaveric model is better and more realistic than other surgical simulation techniques for learning pelvic floor and perineal surgical procedures according to the opinions of urogynecologists and surgeons participating in international postgraduate pelvic floor surgery courses using cadavers embalmed by the Thiel method. STUDY DESIGN An observational prospective study was performed in urogynecologists and surgeons attending international postgraduate pelvic floor and perineal surgery courses using cadavers embalmed by the Thiel method. A survey was completed by the participants after finishing the course. Based on the answers collected, we analyzed the differences, including in the satisfaction degree and teaching level for each surgical procedure, between different surgical simulation models that the participants had already used and the Thiel simulation method employed. RESULTS The students recognized that Thiel cadavers present more similarities to patients than other simulation methods. The Thiel cadaveric method was considered by most responders to be the best for the simulation of surgical procedures on the pelvic floor and perineum. Most of the surgeons surveyed recommended conducting these courses with Thiel cadavers for different colleagues in other specialties as a reliable simulation method for training for difficult surgical procedures. CONCLUSIONS Participants in the course on pelvic floor surgery in Thiel cadavers recognized that this is the most realistic model for surgical simulation and the best way to gain confidence, self-determination and precise surgical skills for performing pelvic floor and perineal surgery.
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Affiliation(s)
- Álvaro Soler-Silva
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain
| | - Antonio Sanchís-López
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain; Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain.
| | | | - Luis Gómez-Pérez
- Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain; Department of Urology, Sant Joan University Hospital, Alicante, Spain
| | - María José Alcaide Quirós
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain; Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
| | - María-Luisa Sánchez-Ferrer
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, El Palmar, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | | | - Arantxa Muñoz-Duyos
- Department of General Surgery, MútuaTerrassa University Hospital, University of Barcelona, Terrassa, Barcelona, Spain
| | - José Manuel Ramírez
- Department of Surgery. Institute for Health Research Aragón. University of Zaragoza. Zaragoza, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain; Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
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Ulrich D, Preyer O, Bjelic-Radisic V, Roithmeier F, Kropshofer S, Huemer H, Umek W, Angleitner-Flotzinger J, Reinstadler E, Tamussino K, Mazanek A, Nemeth Z, Strobl M, Aigmüller T. The Austrian Sacrocolpopexy Registry: Surgical Techniques, Perioperative Safety, and Complications. J Minim Invasive Gynecol 2020; 28:909-912. [PMID: 33144240 DOI: 10.1016/j.jmig.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Sacrocolpopexy (SCP) has become the standard procedure to correct uterovaginal prolapse in women, but techniques and approaches are not standardized. We report the results of the Austrian Sacrocolpopexy Registry, which aimed to collect data on surgical techniques and perioperative outcomes. DESIGN The Austrian Urogynecology Working Group initiated a registry to assess surgical variability and perioperative safety of SCP. The study was performed at 14 centers (13 in Austria,1 in Switzerland). Institutional review board approvals were obtained. PATIENTS Consecutive patients with symptomatic pelvic organ prolapse (POP). INTERVENTIONS SCP in the course of routine POP treatment. MEASUREMENTS AND MAIN RESULTS Preoperative assessment included demographic data, clinical data on bladder, and bowel functions and POP-Q status. Surgical data included surgical approach (open, laparoscopic, robotic), type of mesh, depth of dissection, nerve sparing techniques, suture materials, uterus or cervix-sparing techniques, peritoneal closure, and concomitant surgeries. A total of 401 patients were recruited into the study. The mean age was 57 years (range: 26-84) and mean body mass index was 34. A total of 137 (34%) patients had undergone previous surgery for prolapse and in 264 cases SCP was the primary procedure. A total of 170 (42%) patients had undergone previous hysterectomy; For patients with uterus, SCP was performed with subtotal (n = 148) or total (n = 3) hysterectomy. A total of 285 (71%) SCPs were done laparoscopically, 102 (25%) robotically and 10 (3%) per laparotomy. The conversion rate from laparoscopy to abdominal surgery was 4.5%. Various meshes and suture materials were used and fixation techniques also varied widely. Four patients underwent reoperation within 30 days (2 trocar herniations, and 1 bowel obstruction, 1 compartment syndrome). One patient died of aortic dissection 7 days after SCP. CONCLUSIONS Most SCPs in this registry were performed laparoscopically, but there was considerable variation in surgical techniques. Perioperative morbidity appears modest.
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Affiliation(s)
- Daniela Ulrich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller).
| | - Oliver Preyer
- Department of Obstetrics and Gynecology, Landeskrankenhaus Villach, Villach, (Dr. Preyer)
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller)
| | - Franz Roithmeier
- Department of Obstetrics and Gynecology, Ordensklinikum Linz, Linz, (Dr. Roithmeier)
| | - Stephan Kropshofer
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, (Dr. Kropshofer)
| | - Hansjörg Huemer
- Austria, and Department of Obstetrics and Gynecology, Bethesda Krankenhaus, Basel, Switzerland (Dr. Huemer)
| | - Wolfgang Umek
- Department of Obstetrics and Gynecology, Medical University of Vienna, (Dr. Umek)
| | - Johannes Angleitner-Flotzinger
- Department of Obstetrics and Gynecology Krankenhaus der Barmherzigen Schwestern Ried, Ried im Innkreis, (Dr. Angleitner-Flotzinger)
| | - Evi Reinstadler
- Department of Obstetrics and Gynecology, Krankenhaus Dornbirn, Dornbirn, (Dr. Reinstadler)
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller)
| | - Andrea Mazanek
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, (Dr. Mazanek)
| | - Zoltan Nemeth
- Department of Gynecology, Krankenhaus der Barmherzigen Brüder Vienna, Vienna, (Dr. Nemeth)
| | | | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller); Department of Obstetrics and Gynecology, Landeskrankenhaus Leoben, Leoben (Dr. Aigmüller)
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Ko KJ, Lee KS. Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes. Investig Clin Urol 2019; 60:413-424. [PMID: 31692921 PMCID: PMC6821990 DOI: 10.4111/icu.2019.60.6.413] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
There are a variety of surgical management strategies to help surgeons repair pelvic organ prolapse (POP). Surgical treatment for POP includes native tissue repair, augmentation with mesh, and minimally invasive surgeries. Currently, laparoscopic or robotic techniques for POP repair are increasing in popularity and continuing to evolve. The aim of this review is to present an up-to-date review of surgical techniques used for POP repair and to discuss ways to optimize surgical outcomes.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Updates in Minimally Invasive Approaches to Apical Pelvic Organ Prolapse Repair. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-0257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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RCT of vaginal extraperitoneal uterosacral ligament suspension (VEULS) with anterior mesh versus sacrocolpopexy: 4-year outcome. Int Urogynecol J 2018; 29:1607-1614. [DOI: 10.1007/s00192-018-3687-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/06/2018] [Indexed: 11/26/2022]
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