Purpose of review: Vaginal surgery is the true minimally invasive surgery in the treatment of pelvic organ prolapse (POP); however, the robotic industry and decreased resident training in vaginal surgery may result in the loss of skills among our graduates. There are a number of procedures that are well accepted in the management of prolapse, because they are minimally invasive and with few complications compared with the abdominal approach. In this review, we will discuss various vaginal techniques for complex POP. In our opinion, the most minimally invasive approach is vaginal surgery.
Recent findings: There are no recent significant findings on the vaginal approach to complex pelvic organ surgery and mostly case series about success of robotic procedures. There are a significant number of studies exploring the benefits of robotic surgery. It has been observed that the operating times are longer and there is a learning curve. Although there are advantages to robotic surgery, one must not overlook the significant cost associated with obtaining the robot, the maintenance and the cost of disposable instruments. There is limited evidence to show that robotic surgery did not benefit women with benign gynecological disease in terms of effectiveness or safety.
Summary: POP is a vaginal problem, which is best treated vaginally. There are many well designed studies that support the vaginal approach to primary POP.