title: Extraperitoneoscopic colposuspension using CO2 distension method.
abstract: OBJECTIVE
  To validate our experience in extraperitoneoscopic colposuspension for genuine stress incontinence.
  
  
  METHODS
  Between March 1995 and July 1996, 48 women who had genuine stress incontinence underwent extraperitoneoscopic colposuspension in our institute. After standard laparascopic surgery preparation, a 10 mm puncture site was made midline just in the cm above the pubic hair line, and the extraperitoneal space was developed with the higher pressure of insufflating CO2. A pair of sutures was inserted at the level of the midurethral and unrethrovesical junction with Cooper's ligament.
  
  
  RESULTS
  All of these patients underwent the same procedures. The average blood loss was less than 50 ml, with a range from 10 to 200 ml. The operative time was from 20 to 90 min, with a mean time of 32 min. There was one bladder injury, 2 cases of voiding difficulties and 2 of detrussor instability in our series and the overall complication rate was 10.4%. So far, 45 of the 48 patients are satisfied with the surgery.
  
  
  CONCLUSIONS
  Laparoscopic Burch colposuspension is a practicable surgical procedure for managing stress incontinence. Extraperitoneal space was created easily with the higher pressure of insufflating CO2. An extraperitoneoscopic approach can reduce the necessity of laparscopic suturing. Moreover, it avoids violating the peritonel cavity and reduces the potential risk of postoperative adhesion formation and the discomfort resulting from pneumoperitonium. Thus, extraperitoneal colposuspension affords an alternative to laparoscopic or abdominal retropubic colposuspension in well-selected patients.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Linkou Medical Center, Taipei, Taiwan.
authors.forename: C L
authors.initials: CL
authors.lastname: Lee
authors.forename: C F
authors.initials: CF
authors.lastname: Yen
authors.forename: C J
authors.initials: CJ
authors.lastname: Wang
authors.forename: K G
authors.initials: KG
authors.lastname: Huang
authors.forename: Y K
authors.initials: YK
authors.lastname: Soong
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics
chemical_list: D002245:Carbon Dioxide