Technical video: modified laparoscopic colposuspension.

BACKGROUND

Laparoscopic colposuspension has been shown in some studies to have equivocal results as open colposuspension, and in addition to treating stress incontinence can also reduce anterior vaginal wall compartment prolapse, as described by Burch in 1961 [1].

STUDY

OBJECTIVE

To demonstrate a novel modified technique for laparoscopic colposuspension.

DESIGN

Narrated step-by-step video demonstration of the modified laparoscopic colposuspension technique.

SETTING

Department of Obstetrics and Gynecology, Royal Surrey County Hospital.

INTERVENTION: Initially, 180 mL methylene blue with saline solution is instilled into the bladder for clear identification. Incision and dissection bilaterally, directly onto the ileopectineal ligament (Cooper's ligament) are performed. By using the Kent dissecting knotter, dissection down the space of Retzius to the paravaginal tissues is easily performed. Two 0 Ethibond sutures (Ethicon, Inc., Somerville, NJ) are then placed on each side, between the Cooper's ligament and the paravaginal tissues. These are tied via an extracorporeal knot using the other end of the Kent dissecting knotter. The peritoneal defects are then closed sequentially using 2/0 polyglactin 910 sutures (Vicryl; Ethicon) in a figure-of-eight intracorporeal surgical slip knot technique.

MAIN

RESULTS

The patient had second-degree anterior wall prolapse with proved stress incontinence and descent of the bladder neck observed on video urodynamics. At 8 months after surgery she has no symptomatic or measurable prolapse and no stress incontinence.

CONCLUSION

This modified laparoscopic colposuspension procedure can be used in most cases because it is a transperitoneal technique. It requires substantially less dissection than the traditional techniques do, which results in a markedly reduced operative time.