OBJECTIVE - To describe a technique for safe placement of retropubic midurethral slings, in patients undergoing concomitant laparoscopic surgery, in order to avoid major complications associated with this procedure, as bladder perforation and retropubic hematomas.
DESIGN - Step-by-step video demonstration of the technique.
SETTING - University tertiary care hospital.
PATIENTS - Patients with indication for retropubic midurethral sling placement (recurrent stress urinary incontinence, intrinsic sphincter deficiency, severe pelvic organ prolapse), in which 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 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 as those with previous Burch colposuspension.
CONCLUSION - It 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 arises. Even high risk patients may be safely approached.
Journal of minimally invasive gynecology. 2016 Mar 19 [Epub ahead of print]
Célia Amorim-Costa, Valentina Billone, Benoît Rabischong, Nicolas Bourdel, Gaspare Cucinella, Michel Canis, Revaz Botchorishvili
Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal., Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy., Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France., Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France., Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy., Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France., Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France.