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Gynecology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
JB Dubuisson, J Dubuisson, JM Wenger, A Caviezel
Surgical intervention
2 years ago
2283 views
95 likes
0 comments
07:41
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
A Llueca, JL Herraiz, M Rodrigo, Y Maazouzi, D Piquer, M Guijarro, A Cañete, J Escrig
Surgical intervention
2 years ago
3092 views
123 likes
2 comments
07:16
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
D Limbachiya
Surgical intervention
3 years ago
2073 views
65 likes
0 comments
06:56
Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
A Wattiez, I Argay, F Asencio, J Faria, L Schwartz
Surgical intervention
4 years ago
1793 views
64 likes
1 comment
33:56
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Laparoscopic Burch procedure: colposuspension for stress urinary incontinence (SUI)
We present the case of a 53-year old patient diagnosed with stress urinary incontinence (SUI), who was initially managed by a tension-free vaginal tape obturator system (TVTO) operation one year earlier. Six months after the initial procedure, she reported a recurrence of her urinary symptoms. She was referred to our department and a urodynamic investigation revealed a type II SUI.

Decision is made to perform a laparoscopic Burch colposuspension to reinforce the urethral support. This procedure can be considered a therapeutic option in patients with recurrent symptoms of SUI following vaginal sling procedures.
A Wattiez, J Castellano, C Meza Paul, K Afors, G Centini, R Fernandes, R Murtada
Surgical intervention
4 years ago
3595 views
112 likes
0 comments
13:33
Laparoscopic Burch procedure: colposuspension for stress urinary incontinence (SUI)
We present the case of a 53-year old patient diagnosed with stress urinary incontinence (SUI), who was initially managed by a tension-free vaginal tape obturator system (TVTO) operation one year earlier. Six months after the initial procedure, she reported a recurrence of her urinary symptoms. She was referred to our department and a urodynamic investigation revealed a type II SUI.

Decision is made to perform a laparoscopic Burch colposuspension to reinforce the urethral support. This procedure can be considered a therapeutic option in patients with recurrent symptoms of SUI following vaginal sling procedures.
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
A Wattiez, J Albornoz, M Puga, E Faller
Surgical intervention
6 years ago
1747 views
24 likes
0 comments
32:41
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
M Milad, L Griffin, I Moy, S Bulun
Surgical intervention
7 years ago
2001 views
23 likes
0 comments
03:59
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
A Wattiez, S Barata, AM Furtado Lima, P Trompoukis, B Gabriel, J Nassif
Surgical intervention
8 years ago
429 views
30 likes
1 comment
10:14
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.