ABSTRACT
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common phenomena in women. It is projected that 11.1% of the female population will undergo surgery for the above conditions in their lifetime with 30% of these women requiring reoperations for recurrence.1 Annually, it is estimated that more than 135 000 and 300 000 inpatient surgeries are being performed to correct SUI and POP, respectively, at a combined cost of more than 1 billion US dollars.2,3
The growth in demand for services to care for these disorders will increase at twice the rate of the growth of the population over the next 30 years. Since the introduction of laparoscopic retropubic urethropexy in 1991, laparoscopic approach and techniques have been applied to most abdominal and vaginal procedures for SUI and POP. Recent advances have also included using robotic assistance to perform these laparoscopic procedures. Deciding whether to proceed with laparoscopic surgery is dependent upon the surgeon’s experiences and skills as well as the available facilities and patient preferences. Other considerations include previous history of incontinence and prolapse procedures; patient characteristics such as age, weight, and ability to tolerate general anesthesia; presence of a foreshortened vagina and severe abdominopelvic adhesions; or the need for concomitant transvaginal repairs. Advantages of laparoscopic surgery include improved visualization of retropubic and pelvic anatomy due to magnification from the laparoscope; improved hemostasis; decreased postoperative pain and shortened hospitalization resulting in potential cost reduction; decreased recovery period with quicker return to work; and improved cosmesis from smaller incisions. Disadvantages of laparoscopy include an initial steep learning curve and technical difficulty with laparoscopic dissection and suturing; initial increased operating time; greater hospital costs secondary to increased operating room time and disposable laparoscopic instruments; the need for adequate facilities with knowledgeable ancillary staff; and lack of three-dimensional perspective. These disadvantages, along with limited
training in advanced laparoscopic techniques and the advent of minimally invasive midurethral slings and surgical kits for vaginal prolapse, have thwarted the widespread adoption of laparoscopic surgery for SUI and POP. Therefore, most of the literature, especially concerning prolapse procedures, consists of small series by expert surgeons. As such, the findings are susceptible to various biases and should be interpreted with caution as the efficacy of specific procedures can often be falsely amplified. In this chapter, we examine the procedures for SUI and POP separately by first discussing the anatomy and steps involved in the specific surgeries followed by summaries of the evidence on the efficacy of these different laparoscopic techniques.
