BACKGROUND: Artificial urinary sphincter (AUS) implantation is recommended for women suffering urinary stress incontinence.
Robot-assisted laparoscopy allows improved dexterity and visibility compared to traditional laparoscopy, potentially providing significant advantages for deep pelvic surgery.
OBJECTIVE: To report our surgical technique and initial experience in transperitoneal robot-assisted laparoscopic AUS implantation in women with urinary stress incontinence.
DESIGN, SETTING, AND PARTICIPANTS: Eleven eligible patients with AUS implantation or revision using robot-assisted laparoscopy for urinary stress incontinence were included between January 2012 and February 2014 at Department of Urology, Lille University Hospital.
SURGICAL TECHNIQUE: Procedures were performed with the assistance of a four-arm da Vinci robot. The urethrovaginal space was dissected after transperitoneal access to the Retzius space. An 11-mm port placed in the right iliac fossa allowed introduction of the AUS device. The cuff and balloon tubes were externalised via a 5-mm suprapubic incision. The peritoneum was finally sutured.
MEASUREMENTS: Clinical data were prospectively collected before, during, and after the procedure. Results were classified as complete continence (no leakage and no pad usage), social continence (leakage and/or pad usage with no impact on social life), or failure (leakage and/or pad usage impacting social life).
RESULTS AND LIMITATIONS: After mean follow-up of 17.6 mo (interquartile range 10.8-26 mo), eight patients (72.7%) had a successful AUS implantation, of whom seven (87.5%) reported complete continence and one had social continence. Two vaginal injuries and two bladder injuries occurred intraoperatively. Two patients experienced early minor postoperative complications and two had a major postoperative complication.
CONCLUSIONS: Robot-assisted laparoscopic AUS implantation is a feasible procedure. Further studies will better assess the place of robot-assisted laparoscopy in AUS implantation.
PATIENT SUMMARY: We investigated the treatment of 11 patients with stress urinary incontinence using robot-assisted implantation of an artificial urinary sphincter (AUS). The results show that the procedure is feasible procedure, and future studies will to help assess the place of robot-assisted laparoscopy in AUS implantation.
Written by:
Biardeau X, Rizk J, Marcelli F, Flamand V. Are you the author?
Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France.
Reference: Eur Urol. 2015 Jan 9. pii: S0302-2838(14)01397-9.
doi: 10.1016/j.eururo.2014.12.041
PubMed Abstract
PMID: 25582931