To describe a
technique for
the safe placemen
t of re
tropubic midure
thral slings in pa
tien
ts undergoing concomi
tan
t laparoscopic surgery in order
to avoid major complica
tions associa
ted wi
th
this procedure such as bladder perfora
tion and re
tropubic hema
tomas.
Design
Step-by-step video demonstration of the technique.
Setting
A university tertiary care hospital.
Patients
Patients with an indication for retropubic midurethral sling placement because of recurrent stress urinary incontinence, intrinsic sphincter deficiency, or severe pelvic organ prolapse in whom a concomitant laparoscopic surgery has to be performed for other medical conditions.
Intervention
Laparoscopic opening and dissection of the Retzius space and insertion of the sling under a laparoscopic view of this space.
Measurements and Main Results
This technique has been mainly used in patients undergoing laparoscopic pelvic organ prolapse repair. No complications have been identified so far, even in high-risk patients such as those with previous Burch colposuspension.
Conclusion
This is a simple and reproducible technique for preventing major complications associated with retropubic sling placement in patients undergoing laparoscopic surgery for other reasons. It also permits the immediate detection and even resolution of complications in case any arise. Even high-risk patients may be safely approached.
