Dirk De Ridder

The Laparoscopic Approach to Pelvic Floor Surgery

Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.

Endoscopic Needle Suspensions

In this book dealing with minimally invasive endoscopic and laparoscopic techniques in gynaecology and obstetrics, a chapter concerning the vaginal approach for incontinence surgery may seem somewhat strange. However, vaginal surgery for stress incontinence and prolapse still plays a pivotal role in this era of minimally invasive surgery. Besides simple anterior colporrhaphy with Kelly plication, abdominal approaches are most popular for the treatment of urinary incontinence. Needle suspension was introduced by Armand Pereyra, a US Navy gynaecologist, and further popularised, modified and widely implemented by American urologists from 1957 on. The term endoscopic needle suspension refers to vaginal needle suspension techniques under cystoscopic control. In this chapter, the techniques, indications and results of vaginal needle suspension techniques will be discussed.