A retrospective cohort study of perioperative management on the morbidity of urogynecologic surgery.

INTRODUCTION AND HYPOTHESIS: To determine whether premenopausal and early (<70) and late postmenopausal women whose comorbidities were screened and managed using a standardized protocol experienced comparable perioperative complications after urogynecologic surgery. METHODS: We retrospectively reviewed the charts of all women who presented for surgical management of their pelvic floor disorders over 4.5 years for any complications, which occurred intraoperatively to 6 weeks postoperatively. RESULTS: Late postmenopausal women underwent more vaginal (100/124, 159/246, and 226/288, p < 0.001) and obliterative (15/124, 0/246, and 4/288, p < 0.001), and fewer abdominal (9/124, 87/246, and 58/288, p < 0.001) procedures and had lower body mass index (27.1, 31.4, and 29.4, P < 0.001) and fewer smokers (4/124, 86/246, and 52/288, p < 0.001) than premenopausal and early postmenopausal subjects. After adjusting for these differences, the proportions that experienced perioperative complications were similar among the three groups (P = 0.789). CONCLUSIONS: With standardized screening and management, our premenopausal and early and late postmenopausal women experienced similar perioperative complications.

Use of a Yankauer suction tip combined with the Colpo-Pneumo Occluder balloon to suction the surgical field at the vaginal cuff during robotic hysterectomy.

A 39-year-old patient with complex endometrial hyperplasia without atypia underwent robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The procedure was technically challenging because of the patient's obesity (body mass index 50 kg/m(2)). Concomitant suction of pooled blood and retraction of bowel and omentum were necessary to close the vaginal cuff. An endoscopic retractor was used through the assistant's port, and a Yankauer suction tip was placed through an inflated Colpo-Pneumo Occluder balloon in the vagina to provide directed suction to the vagina cuff. This technique enabled efficient closure of the vaginal cuff.