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A new method for laparoscopic access to the space of Retzius during retropubic cystourethropexy
C H Nezhat1, F Nezhat, D S Seidman
1Department of Gynecology and Obstetrics, Stanford University School of Medicine, California, USA.
Purpose:
We assessed the feasibility of a new technique for laparoscopic dissection of the space of Retzius.
Materials And Methods:
In 10 women 40 to 70 years old (median age 45) undergoing laparoscopic retropubic cystourethropexy for stress urinary incontinence hydrodissection was used to create a pneumo-subperitoneal space. A suction irrigator probe was inserted into a mid peritoneal incision created with a 5 mm. trocar above the symphysis pubis between the 2 umbilical ligaments. The subperitoneal space was developed and insufflated with carbon dioxide without incising the peritoneum.
Results:
All procedures were completed laparoscopically without intraoperative or postoperative complications. Operative time for cystourethropexy ranged from 30 to 70 minutes (median 40). Estimated blood loss ranged from less than 50 to 300 ml. (median 100). Patients were discharged from the hospital within 24 to 48 hours. All patients reported satisfactory relief of symptoms at 3 to 6 months of followup.
Conclusions:
The new technique is not difficult and may minimize tissue injury. Pneumosubperitoneal pressure provides clear exposure of the space of Retzius with minimal bleeding.