Work-related musculoskeletal disorders are prevalent among surgeons but have received little attention owing to under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed to protect surgeons from preventable, potentially career-altering injuries.

Delivery-related strains lead to acute sarcomere elongation, a well-established cause of mechanical injury in skeletal muscles. Sarcomere hyperelongation resultant from mechanical strains is attenuated by pregnancy-induced adaptations acquired by the pelvic floor muscles prior to parturition.

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Mortality and complication rates after colpocleisis are low with urinary tract infection being the most common postoperative complication. Concomitant sling placement does not increase 30-day complication rates.

Purpose of review Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and result in significant disability. We aimed to review the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations of gynecologic surgery. Recent findings Surgeon WMSDs are prevalent, with rates ranging from 66 to 94% for open surgery, 73–100% for conventional laparoscopy, 54–87% for vaginal surgery, and 23–80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages in neck and shoulder strain, it remains associated with trunk, wrist, and finger strain. Summary WMSDs are prevalent among surgeons but have received little attention because of under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed and implemented in order to protect surgeons from preventable, potentially career-altering injuries.

Using a large national database, we identified several patient-related and procedural risk factors for unscheduled 30-day readmission after hysterectomy. Readmission was associated with significantly higher rates of complications, a return to the operating room, and a 30-fold increase in mortality. Our findings reinforce the importance of patient selection and optimization of comorbidities before hysterectomy. Future research should aim to further delineate differential risks of readmission by surgical route as well as modifiable risk factors for readmission.

BACKGROUND Pelvic organ prolapse is prevalent among women with rectal prolapse. OBJECTIVE This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair. DESIGN A retrospective cohort. SETTING This study was performed at a single managed-care institution. PATIENTS Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR−POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR−POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses. RESULTS Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR−POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR−POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR−POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5–18.5) for AR+POP; 14.7 (3.0–72.9) for PR−POP and 31.1 (6.2–154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1–49.3). LIMITATIONS The retrospective design was a limitation of this study. CONCLUSIONS Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract, at http://links.lww.com/DCR/A513.