PFD Week 2018-Laparoscopic Burch Colposuspension: Tips and tricks

Video Transcription

Patients continue to desire operative intervention without the use of mesh for stress urinary incontinence. Laparoscopic birch culpo suspension is a surgical option for treatment  of stress urinary incontinence without the utilization of mesh while remaining minimally invasive. Here's a video of laparoscopic birch culpo suspension  highlighting techniques that we use to facilitate dissection and suture placement. The bladder is back-filled with 300 cc's of sterile water  via 20 French three-way Foley catheter to delineate the anatomical border of the bladder. To gain access retroperitoneally, the peritoneal incision is made approximately  two centimeters superior to the bladder edge.  The space of retzius is entered using electrocautery  as well as blunt and sharp dissection.  Cooper's ligament is dissected and isolated bilaterally prior to doing periurethral dissection.  The bladder is partially drained and further dissection of the retropubic space is performed.  To gain visualization of the pubocervical fascia, the co-surgeon's hand is placed vaginally and the overlying fat lateral to the urethra  is dissected away using a laparoscopic kitner.  Here is a view after dissection is complete.  The Foley cap, which is included in our Foley kits, is placed over the co-surgeon's index finger, which is then used to elevate the vagina for counter traction when placing suture  for the culpo suspension. This also protects the assistant's finger while suturing.  Two separate vicral sutures were placed on the ipsilateral Cooper's ligament, then placed on each side in the pubocervical fascia at the level of the urethrovesical junction  and mid urethra. The respective sutures are pulled through the laparoscopic port and held with separate clamps. The sutures are tied down with a laparoscopic knot pressure  while the co-surgeon elevates the vaginal tissue.  The peritoneum is closed laparoscopically  using delayed absorbable suture. Cystoscopy is then performed with a 70 degree cystoscope, confirming an intact bladder and bilateral ureteral jets.

Video Summary

In this video, the laparoscopic birch culpo suspension technique is highlighted as an alternative surgical treatment for stress urinary incontinence without the use of mesh. The video demonstrates the steps involved in the procedure, starting with filling the bladder with sterile water for visualization. Access to the retroperitoneal space is gained through a peritoneal incision, followed by dissection of the space of retzius and isolation of Cooper's ligament. The pubocervical fascia is visualized with the help of a co-surgeon's hand placed vaginally. Vicral sutures are then placed on Cooper's ligament and the pubocervical fascia, and tied down with laparoscopic knot pressure. The peritoneum is closed, and cystoscopy is performed for confirmation. No credits were mentioned in the transcript. (109 words)

Asset Subtitle

Christine Jeanne Horton, MD

Meta Tag

Category Urinary Incontinence

Category Surgery - Laparoscopic Procedures

Keywords

laparoscopic birch culpo suspension technique

stress urinary incontinence

mesh-free

retroperitoneal space

Cooper's ligament