Laparoscopic-assisted Retropubic Midurethral Sling Placement: A Technique to Avoid Major Complications

Study Objective To describe a technique for the safe placement of retropubic midurethral slings in patients undergoing concomitant laparoscopic surgery in order to avoid major complications associated with this procedure such as bladder perforation and retropubic hematomas. Design Step-by-step video demonstration of the technique. Setting A university tertiary care hospital. Patients Patients with an indication for retropubic midurethral sling placement because of recurrent stress urinary incontinence, intrinsic sphincter deficiency, or severe pelvic organ prolapse in whom a concomitant laparoscopic surgery has to be performed for other medical conditions. Intervention Laparoscopic opening and dissection of the Retzius space and insertion of the sling under a laparoscopic view of this space. Measurements and Main Results This technique has been mainly used in patients undergoing laparoscopic pelvic organ prolapse repair. No complications have been identified so far, even in high-risk patients such as those with previous Burch colposuspension. Conclusion This is a simple and reproducible technique for preventing major complications associated with retropubic sling placement in patients undergoing laparoscopic surgery for other reasons. It also permits the immediate detection and even resolution of complications in case any arise. Even high-risk patients may be safely approached.