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Laparoscopic TOT-like Burch Colposuspension: Back to the Future?
Atanas Aleksandrov1, Moshe Meshulam2, Benoit Rabischong3
1Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Aleksandrov, Meshulam, Rabischong, and Botchorishvili); Department ofObstetrics and Gynecology, Specialised Hospital for Obstetrics and Gynecology SBAGAL Pr. Dimitar Stamatov Varna, Medical University Varna, Bulgaria (Dr. Aleksandrov).
This study introduces a modified laparoscopic Burch colposuspension, termed the "TOT-like Burch," for treating stress urinary incontinence without mesh. This innovative technique offers a safe and effective alternative, reducing dysuric symptoms and providing a mesh-free solution for patients.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
Background:
- The classic Burch colposuspension, developed in 1961, has seen decreased use due to the popularity of vaginal meshes for treating stress urinary incontinence (SUI).
- Recent FDA restrictions on transvaginal meshes highlight the need for effective, non-mesh alternatives for SUI management.
- The original Burch procedure has a notable incidence of voiding difficulties (up to 22%).
Purpose of the Study:
- To demonstrate a modified laparoscopic Burch colposuspension technique, referred to as "laparoscopic transobturator tape (TOT)-like Burch colposuspension."
- To present a mesh-free surgical alternative for patients suffering from stress urinary incontinence.
- To standardize a reproducible and safe surgical procedure for gynecologists.
Main Methods:
- A step-by-step description of the laparoscopic TOT-like Burch colposuspension procedure is provided.
- The technique involves specific trocar placements, dissection of the Retzius space and anatomical structures, and vaginal dissection.
- Suspension of the vagina to Cooper's ligament is achieved using sutures placed at the attachment of the arcus tendinous fascia pelvis and pubourethral ligament, creating lateral traction on the bladder neck.
Main Results:
- The modified technique mimics the lateral traction effect of the transobturator tape (TOT) procedure.
- This lateral suspension aims to reduce the incidence of dysuric symptoms associated with traditional Burch colposuspension.
- The described laparoscopic approach is presented as a safe and effective treatment for SUI.
Conclusions:
- The laparoscopic TOT-like Burch colposuspension is a safe and effective treatment for stress urinary incontinence.
- It offers a valuable alternative to mesh procedures, addressing concerns about synthetic materials.
- The technique provides a mesh-free solution with a potentially lower incidence of dysuric symptoms, making it a viable option for gynecologists.
