Avoiding the Space of Retzius During the Laparoscopic Burch Procedure

Although the structures apposed by a Burch colposuspension, the lateral vaginal fornix and Cooper's ligament, are approached surgically by opening the space of Retzius, neither actually lies in the space of Retzius but in the paravesical-paravaginal space. Cooper's ligament cannot be exposed adequately if the paravesical space is opened laparoscopically. Five primary Burch colposuspensions were performed without opening the space of Retzius, four with the uterus in place and one after a hysterectomy. Approaching the operation through the paravesical space has several advantages. A fixed anatomic landmark for the paravesical space is the umbilical ligament, and it can be easily identified laparoscopically. The paravesical space can be opened without risk of bladder injury. The urachus does not have to be divided. All the advantages of a transperitoneal approach are retained. Suture placement is greatly facilitated. Preliminary experience suggests that a laparoscopic Burch procedure can be carried out easily, quickly, and safely through the paravesical space, but this requires confirmation.