6 engineered by medical device makers and have made their way into the hands of many pelvic ﬂoor surgeons for the purpose of correcting apical and other forms of prolapse. Yet controversy has and continues to surround the use of vaginal mesh particularly as its acceptance in clinical use has outpaced the development of well-designed clinical trials [80]. In 2006, the French Health Authorities (HAS) reported that mesh for transvaginal repair of pelvic organ prolapse should be limited to clinical research [81]. In 2008, the US Food and Drug Administration (FDA) issued a warning regarding the use of mesh for prolapse and incontinence repair [82], repeating that warning in 2011, although narrowing it to vaginal mesh used to correct pelvic organ prolapse (not for anti-incontinence procedures or when used abdominally) [83]. These warnings stemmed from concerns over mesh erosion through the vagina, pain, infection, bleeding, dyspareunia, organ perforation, and urinary problems. While many of these complications are common to all pelvic ﬂoor repairs, mesh erosion and some types of organ perforation are surely unique to mesh and the trocars used for its placement. Presently, with respect to apical prolapse, no published, well-designed, randomized controlled trials have established the superiority of vaginal mesh over native tissue repairs [84]. This is beginning to change with respect to the anterior compartment [85]. What the future holds for vaginal mesh in pelvic organ prolapse repairs is uncertain. Nevertheless, while biomate- rials improve and the subspecialty weighs the appropriate indications for their use, advances in endoscopic repairs for apical prolapse surge forth. It has been the eﬀorts of many physicians from the global scientiﬁc community that have brought forth the modern state of laparoscopy in gynecologic surgery. The pioneering works of Georg Kelling, Hans Christian Jacobaeus, John C. Ruddock, Janos Verees, and Kurt Semm all deserve further mention; however, a discussion of their contributions is beyond the scope of this paper [86–88]. The recent advances in endoscopic technology have been remarkable, and they have allowed urogynecologists to make endoscopic surgery a primary tool in their surgical armamentarium. It has been of great beneﬁt to patients that what many believe to be the most durable apical prolapse repair, abdominal sacrocolpopexy, is achievable via minimally invasive approaches [89]. Presently, a debate exists regarding what method of sacrocolpopexy (straight sticks versus robotic assisted) should become the predominant technique taught and performed by urogynecologist in light of diﬀerences in cost, patient safety, surgeon training, and surgical outcomes. Well-designed studies have started to shed light on this issue [90, 91], but it is a conversa- tion that is only beginning. And yet, in the shadow of that debate gynecologists are already reporting their early experiences with single incision laparoscopic surgery (SILS, or LESS—laparoendoscopic single-site surgery) and natural oriﬁce transluminal endoscopic surgery (NOTES) [92, 93]. Whether these new surgical approaches will be amenable to performing safe and timely apical and other prolapse repairs remains to be seen. Nevertheless, a SILS sacrocolpopexy has been reported [94]. Obstetrics and Gynecology International 9. Conclusion Uterine prolapse is an age-old condition the treatment of which has evolved over thousands of years. It is a condition from which many women have suﬀered and that many physi- cians have attempted to treat. The slow historical progress of the ﬁeld and the challenges that we face today in treating uterine prolapse reﬂect the very intricacies of this disorder that fascinate and inspire us. Today, not only do urogynecol- ogists reap the beneﬁts gleaned from the developments over the ages, but also from the advances in modern technology. We are now positioned to more eﬀectively evaluate and treat this condition and to enhance our understanding of its causes through the pursuit of novel research. References [1] W. J. S. McKay, The History of Ancient Gynaecology, Balliere, Tindal and Cox, London, UK, 1901. [2] C. P. Bryan, Ancient Egyptian medicine : The Papyrus Ebers, Ares Publishers, Chicago, Ill, USA, 1974. [3] J. V. Ricci, The Genealogy of Gynaecology: History of the Development of Gynaecology Throughout the Ages, 2000 B. C.- 1800 A. D, 1950. [4] Soranus and O. Temkin, Soranus’ Gynecology, Johns Hopkins University Press, Baltimore, Md, USA, 1991. [5] F. Adams, The Extant Works of Aretaeus, Nabu Press, Cappado- cian, Turkey, 2010. [6] H. Speert, Iconographia Gyniatrica; A pictorial History of Gynecology and Obstetrics, F. A. Davis, Philadelphia, Pa, USA, 1973. [7] E. H. Gombrich, A little History of the World, Yale University Press, New Haven, Conn, USA, 2005. [8] A. Pare´, The Workes of That Famous Chirurgion Ambrose Par´e, Richard Cotes and Willi Du-Gard, London, UK, 1649. [9] H. van Deventer, The Art of Midwifery Improved, E. Curll, London, UK, 1716. [10] J. V. Ricci, One Hundred Years of Gynaecology 1800–1900 : A Comprehensive Review of the Specialty During Its Greatest Century with Summaries and Case Reports of All Diseases Pertaining to Women, The Blakiston Company, Philadelphia, Pa, USA, 1945. [11] H. L. Hodge, On Diseases Peculiar to Women, Including Displacements of the Uterus, Blanchard and Lea, Philadelphia, Pa, USA, 1860. [12] H. Speert, Obstetric and Gynecologic Milestones: Essays in Eponymy, Macmillan, New York, NY, USA, 1958. [13] C. Goodyear, Inventor. Improvement in India-Rubber Fabrics. US patent 36331844. [14] W. D. Buck, “A raid on the uterus,” New York Medical Journal, vol. 5, p. 464, 1867. [15] R.. Pichevin, “Vaginal hysterectomy,” The British Gynaecologi- cal Journal, vol. 11, 1985. [16] L. LeFort, “Nouveau Proce´de´ pour la gue´rison du prolapsus ute´rin,” Bulletin g´en´erale de Therapeutic, vol. 92, pp. 337–344, 1877. [17] R. M. V. Olshausen, “Ueber ventrale Operation bei Prolapsus und Retroversio uteri,” Zentralblatt fur Gynakologie, vol. 13, 1886. [18] L. A. Emge and R. B. Durfee, “Pelvic organ prolapse: four thousand years of treatment,” Clinical Obstetrics and Gynecol- ogy, vol. 9, no. 4, pp. 997–1032, 1966.