Laparoscopic-guided TVT placement after prior colpo-suspension

Previous retropubic surgery, such as laparoscopic Burch colpo-suspension, can significantly alter the anatomy of the space of Retzius due to fibrosis and scarring. These changes increase the technical difficulty and risk of complications during subsequent retropubic procedures, particularly midurethral sling placement.

To demonstrate the feasibility and safety of laparoscopic-assisted tension-free vaginal tape (TVT) placement in a patient with recurrent stress urinary incontinence (SUI) following prior colpo-suspension.

A 74-year-old woman with recurrent stress urinary incontinence following laparoscopic Burch colpo-suspension performed five years previously.

Retropubic TVT placement was performed under simultaneous laparoscopic guidance at a tertiary gynaecological centre. Intraoperative laparoscopy enabled visualisation of the retropubic space, revealing significant fibrosis and distorted anatomy. Needle passage and sling positioning were performed under direct visualisation. Because extensive retropubic dissection reduced the usual tissue support of the tape, it was temporarily secured with a rapidly absorbable suture to maintain its position without increasing suburethral tension.

Laparoscopic-assisted TVT placement is a feasible and safe approach in patients with prior retropubic surgery. Direct visualisation allows identification of altered anatomical planes, facilitating controlled needle passage and potentially reducing the risk of complications.

This video demonstrates the importance of avoiding blind needle insertion in patients with prior colposuspension and highlights laparoscopic guidance as a valuable strategy to improve safety during retropubic sling procedures.