Clinical Images of Laparoscopic Burch Colposuspension

We routinely perform open laparoscopy technique at the inferior margin of the umbilicus using 10-mm port to introduce the laparoscope. Three additional ports are placed under direct vision. The abdomen is insufflated with CO2 to 15 mmHg intraabdominal pressure. The superior edge of bladder is identified by retrograde filling the bladder. A peritoneal incision is made between the umbilical ligaments approximately 3cm superior to the bladder and the retropubic space entered. Anatomical landmarks including the pubic symphysis, bladder neck, obturator neurovascular bundle, Cooper’s ligament and the arcus tendineus fascia pelvis are identified. If the patient has a cystocele, we recommend laparoscopic paravaginal repair prior to performing the laparoscopic Burch. By performing this first, normal anatomic support of the anterior vaginal segment is recreated, decreasing risk of subsequent voiding obstruction due to overcorrection of the paraurethral Burch sutures. The laparoscopic Burch colposuspension is performed using nonabsorbable sutures. The surgeon’s non dominant hand is placed in the vagina and a finger is used to elevate the vagina around the bladder neck area. Blunt dissection is performed to identify the bladder neck and mid-urethra both sides. The first suture is placed 2 cm. laterals to the urethra at the level of the mid-urethra. The full thickness of the anterior vaginal wall except the epithelium is sutured with a figure of eight fashion. Then the needle passed through the ipsilateral Cooper’s ligament. The suture is tied down with a series of extracorporeal knots. The suture should bridge approximately 2-3 cm. to avoid overcorrection. Two sutures on each side is standard and an increased cure rate has been shown compared to one suture on each side [13]. The second suture is placed at the urethrovesical junction approximately 2 cm. lateral to the bladder edge adjacent to the first suture with similar fashion. The procedure is repeated on the opposite side. After completed, cystoscopy is routinely performed to rule out urinary tract injury. After cystoscopy, the anterior peritoneal defect is closed using absorbable suture with continuous fashion.