[Endoscopic extraperitoneal colposuspension]

The authors point out the advantages and the inconveniences of the different surgical procedures (conventional surgery, transperitoneal celioscopy and extraperitoneal endoscopy) performed in order to treat urinary stress incontinence. An original extraperitoneal endoscopic procedure, using a non resorbable mesh (polypropylene), is proposed. The technique is based on the principle of the open approach described by Burch. The short branches of an Y shaped mesh are sutured at the antero-lateral walls of the vagina. The basis of the Y is pulled out of the extraperitoneal space by using a grasper introduced through a short incision of the skin and the subcutaneous tissues, and perforating the aponeurosis of the rectus muscle. This technique provides the surgeon with an effective and strong tension on the mesh under endoscopic view control. The basis of the mesh is then fixed at the insertion of the rectus muscle on the pubic bone.