title: Technical video: modified laparoscopic colposuspension.
abstract: BACKGROUND
  Laparoscopic colposuspension has been shown in some studies to have equivocal results as open colposuspension, and in addition to treating stress incontinence can also reduce anterior vaginal wall compartment prolapse, as described by Burch in 1961 [1].
  
  
  OBJECTIVE
  To demonstrate a novel modified technique for laparoscopic colposuspension.
  
  
  METHODS
  Narrated step-by-step video demonstration of the modified laparoscopic colposuspension technique.
  
  
  METHODS
  Department of Obstetrics and Gynecology, Royal Surrey County Hospital.
  
  
  METHODS
  Initially, 180 mL methylene blue with saline solution is instilled into the bladder for clear identification. Incision and dissection bilaterally, directly onto the ileopectineal ligament (Cooper's ligament) are performed. By using the Kent dissecting knotter, dissection down the space of Retzius to the paravaginal tissues is easily performed. Two 0 Ethibond sutures (Ethicon, Inc., Somerville, NJ) are then placed on each side, between the Cooper's ligament and the paravaginal tissues. These are tied via an extracorporeal knot using the other end of the Kent dissecting knotter. The peritoneal defects are then closed sequentially using 2/0 polyglactin 910 sutures (Vicryl; Ethicon) in a figure-of-eight intracorporeal surgical slip knot technique.
  
  
  RESULTS
  The patient had second-degree anterior wall prolapse with proved stress incontinence and descent of the bladder neck observed on video urodynamics. At 8 months after surgery she has no symptomatic or measurable prolapse and no stress incontinence.
  
  
  CONCLUSIONS
  This modified laparoscopic colposuspension procedure can be used in most cases because it is a transperitoneal technique. It requires substantially less dissection than the traditional techniques do, which results in a markedly reduced operative time.
authors.affiliation: Department of Obstetrics and Gynecology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kent
authors.affiliation: Department of Obstetrics and Gynecology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England.
authors.forename: Haider
authors.initials: H
authors.lastname: Jan
authors.affiliation: Department of Obstetrics and Gynecology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England. Electronic address: fevzi@doctors.org.uk.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Shakir
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*
keywords: Laparoscopic modified colposuspension; Pelvic floor surgery; Stress incontinence