ABSTRACT Purpose: To compare laparoscopic gynecological surgery training between a developed country’s reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center’s TI. Methods: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. Results: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. Conclusions: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient’s center with comparable surgical outcomes.

Overview and aims: To analyze all patients needing surgical treatment for complications related to laparoscopic sacropexy and their clinical management. Study Design: Case series. Population: All women submitted to surgical treatment of complications related to laparoscopic sacropexy for pelvic organ prolapse treatment on a tertiary referral center (university hospital), from January 1998 to December 2013. Methods: Retrospective analysis of the patients' clinical records. Results: Thirty-three patients were submitted to surgery due to complications related to the procedure, some more than once, with more than one complication registered. There were 6 general surgical complications (2 hematomas, 2 peritonitis, 1 mechanical bowel obstruction due to small bowel incarceration and 1 vaginal wall necrosis) and 34 mesh related complications (27 vaginal mesh exposures, 4 periprosthetic abscesses, 1 vesicovaginal fistula, 1 rectovaginal fistula and 1 posterior mesh retraction). Mean time between prolapse surgery and the first surgery for complication treatment was 18.2 ± 25.3 months (3 days - 131 months). The average number of surgeries needed was 1.8 ± 1.5(1- 6). Conclusions: Surgeons should be aware of the risk factors for complications. Longterm complications should not be neglected. After a mesh placement, patients are at risk for requiring multiple surgeries to resolve complications, which can be challenging, ineffective and expose patient to new ones.