Laparoscopic Burch’s For S.U.L. :
Patient presents to us for distressing symptom – passing of urine on coughing or straining/laughing/weight lifting. Pre-operative assessment should be done to understand hyper mobility of mid-urethra & U-V junction and Detrusal instability should be excluded before operation.
Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images – and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed.
Space of Retzius is dissected easily till both cooper’s ligament is seen well. Mid-urethra & U-V junction dissected after elevating from below by assistant. Non-absorbable suture stitch is taken from mid-urethra & from U-V junction to Cooper’s ligament. Preoperative counseling is necessary for entire procedure & possible post-operative results. Laparoscopic approach has advantage of treating posterior & mid compartment defects repair simultaneously. This surgery requires lot of experience & expertise. Burch’s procedure gives better result than Kelly’s plication & needle suspension procedures. Cystoscopy is necessary to rule out possible bladder injury. Patient can be offered TVT or TOT as optional treatment as it is very easy and effective.
Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.
Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 55 to 75 minutes only. For more complicated case it may take 1-2 hours. Most begin feeling much better within 2-3 days.