Pelvic floor disorders (PFDs) are complex conditions that impact millions of women worldwide. It is estimated that PFDs will affect approximately 30%–50%of women older than 50 years and incur a 20% lifetime risk of undergoing at least 1 surgical procedure to repair either pelvic organ prolapse (POP) or stress urinary incontinence (SUI) by age 80 years [1]. The surgical costs alone are estimated to exceed $10 billion annually [1–6], and this does not account for the cost of nonsurgical and conservative treatments. Although a large body of epidemiological literature provides important information regarding the risk factors for PFDs, the pathogenesis of POP and SUI continues to be poorly understood. Consequently, POP and SUI are associated with significant health care expenditure primarily due to lack of preventive measures, high failure rate of available interventions, and the need for retreatments. Furthermore, the long-standing gaps in mechanistic insights into the pathophysiology of POP and SUI represent one of the major barriers to the development of scientifically rational preventive and therapeutic strategies. Women’s health across the life span depends on a better understanding of the anatomy and physiology of the female pelvic floor (PF) and the causal links between the multifactorial epidemiological risk factors and POP/SUI.

Study Objective: To determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection. Design: A multicenter prospective cohort study. Setting: Ten institutions in the United States. Patients: Patients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded. Interventions: Benign gynecologic surgery. Measurements and Main Results: The primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4–50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks). Conclusion: In this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.

Pelvic floor disorders (PFDs) are complex conditions that impact millions of women worldwide. It is estimated that PFDs will affect approximately 30%–50% of women older than 50 years and incur a 20% lifetime risk of undergoing at least 1 surgical procedure to repair either pelvic organ prolapse (POP) or stress urinary incontinence (SUI) by age 80 years.1 The surgical costs alone are estimated to exceed $10 billion annually,1–6 and this does not account for the cost of nonsurgical and conservative treatments. Although a large body of epidemiological literature provides important information regarding the risk factors for PFDs, the pathogenesis of POP and SUI continues to be poorly understood. Consequently, POP and SUI are associated with significant health care expenditure primarily due to lack of preventive measures, high failure rate of available interventions, and the need for retreatments. Furthermore, the long-standing gaps in mechanistic insights into the pathophysiology of POP and SUI represent one of the major barriers to the development of scientifically rational preventive and therapeutic strategies. Women’s health across the life span depends on a better understanding of the anatomy and physiology of the female pelvic floor (PF) and the causal links between the multifactorial epidemiological risk factors and POP/SUI.

Objectives: Robotic sacrocolpopexy has been rapidly incorporated into surgical practice without comprehensive and systematically published outcome data. The aim of this study was to systematically review the currently published peer-reviewed literature on robotic-assisted laparoscopic sacrocolpopexy with more than 6 months of anatomic outcome data. Methods: Studies were selected after applying predetermined inclusion and exclusion criteria to a MEDLINE search. Two independent reviewers blinded to each other's results abstracted demographic data, perioperative information, and postoperative outcomes. The primary outcome assessed was anatomic success rate defined as less than or equal to pelvic organ prolapse quantification system(POP-Q) stage 1. A random effects model was performed for the meta-analysis of selected outcomes. Results: Thirteen studies were selected for the systematic review. Metaanalysis yielded a combined estimated success rate of 98.6% (95% confidence interval, 97.0%Y100%). The combined estimated rate of mesh exposure/erosion was 4.1% (95% confidence interval, 1.4%Y6.9%), and the rate of reoperation formesh revision was 1.7%. The rates of reoperation for recurrent apical and nonapical prolapse were 0.8% and 2.5%, respectively. The most common surgical complication (excluding mesh erosion) was cystotomy (2.8%), followed by wound infection (2.4%). Conclusions: The outcomes of this analysis indicate that robotic sacrocolpopexy is an effective surgical treatment of apical prolapse with high anatomic cure rate and low rate of complications.