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Background Data concerning laparoscopic sacrocolpopexy (LSCP) in elder women are scarce. We compared intra-operative and early-postoperative complications associated with laparoscopic colpo-, cervico-, or hysteropexy in women under and above 70 years. Methods Retrospective assessment by an independent investigator of a prospective cohort of 571 consecutive women undergoing LSCP in a tertiary unit over an 18-year period. Data included were patient demographics, operative variables, intra-operative, and early (≤ 3 months) postoperative complications. Complications were graded according to the Clavien-Dindo classification and mesh complications categorized using the International Urogynaecological Association (IUGA)-classification. Findings Median age was 66 (IQR 15, range 27-91) and 204 (35.7%) patients were older than 70 years. There were no deaths. Strategic conversion rate was 2.3% (13/571), the majority because of extensive adhesions yet early in our experience. Reactive conversion rate was 0.7% (4/571). Among 554 patients who had a completed LSCP, there were 20 intra-operative complications (3.6%), mostly bladder (1.3%) and vaginal (1.1%) injuries. Eighty-four patients had a total of 95 early-postoperative Dindo ≥ II complications (15.1%). Most common complications were infectious and treated medically (Dindo II). Clinically major complications are rare (III = 3.1% and IV = 0.2%). Reoperation for suspected bleeding (IIIb = 0.7%) was the most common reintervention, typically without demonstrable cause. Most mesh complications were vaginal exposures. Septuagenarians were not more likely to have an intra-operative (4.0 vs 3.3% p = 0.686) or early-postoperative complication (13.6 vs 16.0% p = 0.455) than younger patients. Mesh complications were also equally uncommon. Conclusions LSCP is as well-tolerated by women above 70 years as by younger women.

Postoperative pain is related to the gas used for laparoscopy as demonstrated for 100 % nitrous oxide in 2002 by Tsereteli. In a previous trial, we demonstrated that the use of full conditioning adding 10 % nitrous oxide and 4 % oxygen to the CO2 pneumoperitoneum with humidification and altering the temperature of the insufflation gas, the use of Hyalobarrier gel, and the administration of 5 mg dexamethasone significantly reduced postoperative pain and decreased adhesions. As we believed that just altering the insufflation gas by adding 10 % of nitrous oxide and 4 % of oxygen would reduce pain and adhesions by itself, we performed a randomized controlled trial on women undergoing robot-assisted laparoscopic myomectomy. Fourteen women undergoing robot-assisted laparoscopic myomectomy were randomized 1:1 receiving 86 % CO2 + 10 % N2O + 4 % O2 or 100 % CO2. Outcome parameters were postoperative pain (visual analog scale (VAS)) and adhesions observed at second-look laparoscopy after 14 days. Pain and painkiller intake were significantly reduced by using the altered insufflation gas (p < 0.05). Adhesions did not show a significant difference, although the study group tended to have less adhesions (p < 0.21). Addition of 10 % N2O and 4 % O2 to the pneumoperitoneum significantly decreased postoperative pain, even in a low number of participants, which suggests a strong effect.