Laparoscopic colposuspension with a transvaginal illuminator.

A series of 63 women with anatomic stress urinary incontinence were treated at two institutions by laparoscopic urethrovesical suspension with vaginal transillumination of the paraurethral endopelvic fascia to facilitate laparoscopic dissection and ligature carrier and suture needle placement. In no case did illumination-assisted suture placement require suture removal or replacement for inadequate or traumatic placement within the bladder, or was it associated with hemorrhage. At a minimum of 2 years' follow-up, there were six treatment failures. The reusable illuminator enhances visual contrast between the pelvic floor and bladder neck for laparoscopic dissection and paraurethral needle placement. It also provides an effective backstop to the needle, eliminates needle injuries to operators' fingers during suturing, stabilizes the endopelvic fascia during dissection, and increases visual contrast between the bladder neck and adjacent endopelvic fascia.