The use of a novel sensorized simulation platform for real-time labor progression assessment.

OBJECTIVE: To prove the potentialities of an integrated and sensorized childbirth platform as an innovative simulator for education of inexperienced gynecological and obstetrical medical students. METHODS: A total of 152 inexperienced medical students were recruited to a simulation program on labor progression evaluation. After an introductory lecture on basic concepts of labor and birth given by an expert gynecologist, three different gynecologic scenarios were simulated using both a traditional obstetric simulator and the innovative proposed platform, for a total of six tests for each student. A score was assigned for each performed scenario, based on its correctness. Self-assessment questionnaires were compiled before and after the simulation program for additional subjective assessment. RESULTS: Median score of the simulations performed with our platform was significantly higher than that of the simulations performed with a traditional simulator, for all the three experimented scenarios (P < 0.001). CONCLUSIONS: The use of a sensorized platform for labor progression allowed for an accurate and faster diagnosis if compared with a traditional simulator even for inexperienced operators, supporting its use in clinical training, which could be realistically introduced into the clinical practice for medical student education.

Role of robotic surgery on pelvic floor reconstruction.

Over the past two decades, minimally invasive surgery (MIS) abdominal surgery has increasingly been used to treat pelvic organ prolapse. Besides the several advantages associated with minimal invasiveness, this approach bridged the gap between the benefits of vaginal surgery and the surgical success rates of open abdominal procedures. The most commonly performed procedure for suspension of the vaginal apex for postoperative vaginal prolapse by robotic-assisted laparoscopy is the sacrocolpopexy. Conventional laparoscopic application of this procedure was first reported in 1994 by Nezhat et al. and had not gained widespread adoption due to lengthy learning curve associated with laparoscopic suturing. Since FDA approval of the da Vinci® robot for gynecologic surgery in 2005, minimally invasive abdominal surgery for pelvic organ prolapse has become increasingly popular, as robotic-assisted laparoscopic sacrocolpopexy is an option for those surgeons without experience or training in the conventional route. Robotic surgery has made its way into the armamentarium of POP treatment and has allowed pelvic surgeons to adapt the "gold standard" technique of abdominal sacrocolpopexy to a minimally invasive approach with improved intraoperative morbidity and decreased convalescence. In fact, repair of pelvic organ prolapse can be performed robotically, and sometimes surgeons can feel suturing and dissection during the procedures less challenging with the assistance of the robot. However, even if robotic surgery may confer many benefits over conventional laparoscopy, these advantages should continue to be weighed against the cost of the technology. To date, as long-term outcomes, evidence about robotic sacrocolpopexy for a repair of pelvic organ prolapse are not conclusive, and much more investigations are needed to evaluate subjective and objective outcomes, perioperative and postoperative adverse events, and costs associated with these procedures. It is plausible to think that the main advantage is that robotics may lead to a widespread adoption of minimally invasive techniques in the field of pelvic floor reconstructive surgery. The following review will address the development and current state of robotic assistance in treating pelvic floor reconstruction discussing available data about the techniques of robotic prolapse repair as well as morbidity, costs and clinical outcomes.