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Robotic Burch colposuspension—modified technique
... Thus, some surgeons may offer Burch colposuspension to selected patients. [67] Robotic Burch colposuspension has been described in 2015 [68] with another case reported in 2017 [69] and a small-sample randomized trial has been conducted that compared robotic vs. open abdominal hysterectomy with concomitant Burch procedure, which demonstrated similar outcomes between the two approaches. [70] When compared to a mid-urethral sling, one disadvantage of the Burch colopsuspension is that in case of postoperative voiding dysfunction, it is much simpler to cut or loosed a sling compared to removing retropubic sutures. ...
... Owing to the cost of robotic surgery, authors have suggested that robotic Burch colposuspension should be used mostly when a concomitant robotic abdominal procedure is planned. [68][69][70] In conclusion, over the past decade, robot-assisted surgery has spread significantly in female pelvic medicine and reconstructive surgery, with almost all the open surgical procedures being performed with the robotic approach. While the outcomes of robotic surgery in this area are promising, studies that properly evaluate the benefits of robotic surgery over open and laparoscopic approaches are still lacking. ...
In this article, we review the current uses and future directions of robotic surgery in the field of female pelvic medicine and reconstructive surgery. Pelvic surgery is ideal for the use of surgical robots, which provide improved visualization and ease of suturing deep within the pelvis. Robots have been successfully used for the treatment of pelvic organ prolapse, in procedures such as sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication. Surgeons have used the robotic successfully to treat various etiologies of female pelvic pain including fibroids, endometriosis, and nerve entrapment. Robotic repair of iatrogenic injury has been described with excellent outcomes and avoidance of conversion to open surgery in the event of an injury caused using the robotic platform. While more data is needed on this topic, there has been increasing interest in using the robot for urologic reconstruction including repair of vesico-vaginal fistula, cystectomy, augmentation cystoplasty, and continent and non-continent diversions. Recently the use of the robot has been described in the treatment of stress urinary incontinence in females, with robotic placement of an artificial urinary sphincter. While robotic surgery is associated with increased cost, the outcomes of robotic surgery in female urology are promising. More studies that properly evaluate the benefits of robotic surgery as compared to open and laparoscopic approaches are needed.
... The robotic Burch urethropexy was first reported by Francis and colleagues in 2015. The cost of robotic surgery procedures is known to be significant, and the authors propose that a robotic approach in this pathology is particularly useful in patients that benefit from other concomitant robotic surgeries, especially in the pelvic area [36,37]. ...
Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.
... A randomized control trial comparing the efficacy of the laparoscopic Burch urethropexy to retropubic MUS (RMUS) showed higher objective cure rate for RMUS at 1 year [12] but similar subjective outcomes at 4-8 years [13]. However, no studies to date have compared RA-Burch urethropexy to RMUS and only a handful of studies have examined the RA-Burch as a reasonable treatment for SUI, thus prompting this study [14][15][16]. ...
Synthetic retropubic midurethral slings (RMUS) and robotic-assisted Burch urethropexies (RA-Burch) are common surgical treatment options for stress urinary incontinence (SUI). Few data exist comparing the success of these two retropubic surgeries. This retrospective cohort study of RA-Burch and RMUS procedures compared the proportion of patients with subjective cure after RA-Burch compared to RMUS at our institution between 2016 and 2020. Subjective cure was defined as reporting no symptoms of SUI at longest follow-up. Chi-square, Fisher’s exact, Mann–Whitney U tests, logistic regression, and Kaplan–Meier log-rank tests were used in analyses. The overall cohort of 235 subjects included 47 RA-Burch cases matched 1:4 with 188 RMUS cases. Patients who underwent RA-Burch were younger (p < .01), had lower BMIs (p = .04), and were more likely to have concomitant procedures, including hysterectomy (p < .01). There was no difference in subjective cure at longest follow-up (p = .76). Median follow-up was longer in the RA-Burch group (p < .01). There was no difference in early postoperative complications, EBL, treatment for persistent SUI, or new urge urinary incontinence at longest follow-up. Both groups experienced postoperative urinary retention at a similar rate, although 4 RMUS patients required sling lysis and one patient experienced a mesh exposure. Patients undergoing RA-Burch had significantly longer OR times when no concomitant procedure was performed (p < .01). There were no significant predictors of SUI recurrence when controlling for baseline variables. This study suggests that RA-Burch and RMUS may be equally efficacious for patients with symptoms of SUI desiring surgical management.
... Both these patients were continent at 1 year, with the group concluding that the robotic approach was an effective modality in female SUI [19]. Since then isolated reports in single patients focusing on technique and modifications can be found in the literature, but larger patient numbers and longterm follow-up of this technique remains lacking [20,21]. ...
The suspension of use of sub-urethral mesh in the UK in 2018 has seen the resurgence of colposuspension in female SUI surgery. Open and laparoscopic colposuspension techniques are well recognised. We present data from 28 robotic-assisted laparoscopic colposuspension (RALCp) procedures, reporting on technique, safety and efficacy. Approval was obtained from the hospital New and Novel Procedures Committee. All patients had urodynamic assessment prior to surgery. Data was prospectively gathered and 24-h pad usage and Urinary Incontinence Short Form Questionnaire (ICIQ-UI-SF) scores were used to assess symptom severity and quality of life. PGII scores were used to assess patient satisfaction after the procedure. Paired T test analysis was conducted. Since May 2019, robotic colposuspension has been performed in 28 patients. The mean age and BMI were 49 and 27 (kg/m²), respectively, with a mean follow-up period of 12 months. 67.9% of patients had pure urodynamic SUI and 32.1% of patients had previous anti-SUI surgery. Average operating time was 127 min, blood loss 20 ml and length of stay 2 days. There was a significant 73% improvement in mean 24-h pad usage (p = 0.001) and an improvement in mean ICIQ-UI-SF scores from 18.1 to 9.4 (p = 0.0001). Day 1 mean pain score was 5/10. This is the largest series of its kind. Robotic colposuspension is safe and feasible with significant improvements seen in quality of life scores and number of pads used per day. It presents a minimally invasive treatment option in female SUI, however needs larger volume evaluation and longer follow-up for further evaluation.
... The patient that was followed up to 6 months could be continent and voiding without residual urine. 15 Open abdominal approach for POP has high cure rate, however, she must have a larger wound, more wound pain, and longer hospital stay. Laparoscopic approach for POP has advantages of minimal wound, less pain, and short hospital stay; however, the lower success rate was noted. ...
Pelvic organ prolapse (POP) is the descent of the female organs that result in a protrusion of the vagina and/or uterus. Women often present with multiple complaints including bladder, bowel, and pelvic symptoms. Urinary retention was the symptom that woman presents uncommonly. Treatments of urinary retention were including removing the etiology of compression of the urethra and rescuing the normal position of pelvic organs. Surgery may be by abdominal, vaginal, or laparoscopic or robotic approach according to doctor's skillfulness, patient's need, and involving pelvic organs. Robotic technology has advantages of minimally invasive surgery such as reduced postoperative pain, shorter hospital stay, and quicker recovery times. It also has advantages of faster performance times, increased accuracy, enhanced dexterity, more accessible and more comfortable suturing, and a lower number of errors when compared to conventional laparoscopic instrumentation. Hence, it could be performed complex surgery such as this case. We present a case of multiple uterine myomas with compression symptoms and occult stress urinary incontinence. At the case of paravaginal wall defect with stress incontinence, she underwent robotic Burch colposuspension and paravaginal repair. Robotic pelvic reconstruction can be accomplished safely and efficiently and should be considered as an option for patients who had POP with urinary incontinence and who are prepared undergoing robotic surgery.
... Successful feasibility studies on the role of robotic-assisted surgery in SUI and voiding dysfunction after urogynaecological surgery have been conducted over the last 3-4 years (56,57). Modified single-series robotic-assisted approaches have been described in the contemporary literature with successful outcomes (58). No study has compared the outcomes of robotic-assisted techniques with either open or laparoscopic colposuspension. ...
Pelvic floor dysfunction (PFD) is a clinical entity that is predominantly common in females. Determining the exact underlying cause of PFD can be difficult, and making surgical intervention may be challenging. The PFD can affect the quality of life of the patient by causingstress urinary incontinence (SUI), pelvic organ prolapse (POP) or a combination of both. There are well-defined surgical treatment options for PFD, with minimally invasive approaches and novel techniques are recently being introduced. We here evaluated management options in patients presenting with SUI and POP focussing on novel and minimally invasive treatment modalities and their implications on future uro-gynaecological practice. The current literature was researched for relevant articles in Medline and EMBASE databases by using the following keywords: pelvic floor dysfunction, minimally invasive procedures, stress urinary incontinence, pelvic organ prolapse and novel techniques. The review of the traditional treatment options for both SUI and POP are beyond the scope of this review. There has been continuing evolution and development in laparoscopic and robotic surgery to treat PFD. These minimally invasive techniques will soon substitute open procedures. Alternative novel treatment modalities have also been developed from new human compatible materials and are emerging as successful treatments for SUI. We here presented the findings of a review of the contemporary literature relating to the development of these various treatment options, and their implications for future surgical practice in this field of uro-gynaecology.
Introduction and hypothesis:
Up to 13.6% of women will undergo surgical treatment for stress urinary incontinence during their lifetime. Midurethral slings are the mainstay of stress incontinence treatment; however, diversity of surgical options is needed to serve the large number of patients desiring treatment. The Burch colposuspension remains a viable treatment option for appropriately selected patients. Currently, information on procedural standardization and tools for surgical training on robot-assisted colposuspension is limited.
Methods:
We describe a stepwise robotic approach aimed at enhancing procedural reproducibility, while decreasing risks of intraoperative injury and postoperative complications. We analyze perioperative outcomes of our technique in a retrospective cohort of patients who underwent robot-assisted colposuspension at our institution.
Results:
Seven key procedural steps are defined to optimize safe dissection in the retropubic space and to reduce the potential for surgical complications. These include methods of avoiding bladder, urethral, and neurovascular injury, as well as enhancing adequate suture fixation that prevents urethral obstruction and adverse postoperative urinary and pain-related symptoms. Surgical outcomes for 20 patients are reported and reveal low rates of perioperative complications.
Conclusion:
Robot-assisted colposuspension requires thorough knowledge of the retropubic space and the application of standardized techniques may reduce the risk of injury and optimize procedure efficiency and reproducibility.
Burch urethropexy is one of the earliest and most effective surgeries for stress urinary incontinence. Minimally invasive robotic surgery is becoming more popular in the field of urogynecology. Herein, we present the safety and efficacy of a large case series of robotic-assisted Burch urethropexy. A retrospective chart review was performed on robotic-assisted Burch urethropexy cases performed between 2013 and 2019. Patient characteristics, perioperative data and follow-up outcomes were collected at a single teaching institution. A total of 76 women underwent robotic-assisted Burch urethropexy for pure stress urinary incontinence. Fifty of them had concomitant robotic procedures at the time of the Burch. We performed the robotic-assisted Burch urethropexy alone on 26 patients. The mean age was 55 years old. The overall treatment success rate was 85% with a mean follow-up time of 134 (±157.8) days. Complications included cystotomy (3%), urinary tract infection (16%) and postoperative voiding dysfunction (10%). Our study reveals that robotic-assisted Burch urethropexy is a feasible option in the treatment of stress urinary incontinence in terms of operative outcomes and short-term efficacy.
• Impact statement
• What is already known on this subject? Minimally invasive robotic surgery is becoming more popular in the field of urogynecology. Surgical repairs for stress urinary incontinence will likely increase in the coming years secondary to an aging population. Burch urethropexy is one of the earliest and most effective surgeries for stress urinary incontinence and can be performed abdominally, laparoscopically and now, using robotic assistance.
• What do the results of this study add? This study reveals that robotic-assisted Burch urethropexy is a feasible option in the treatment of stress urinary incontinence in terms of intraoperative outcomes with good short-term efficacy.
• What are the implications of these findings for clinical practice and/or further research? Lately, interest in colposuspension procedures has been rekindled as physicians seek alternative stress urinary incontinence treatment options. Robotic-assisted Burch urethropexy will continue to gain popularity with its efficacy and safety.
Objective
To share our experience and techniques of robot assisted repair of complex vesico-vaginal fistulae.
Methods
Prospectively maintained data of patients undergoing robot-assisted repair of complex VVF from December 2014 to October 2019 were analysed. Patient characteristics, operative data, post-operative events and follow up outcomes were noted. All cases underwent pre-operative cysto-vaginoscopy and upper tract imaging. The procedure was completed in a standard fashion. Additional procedures included Boari flap reimplantation, Burch-colposuspension, ureteric reimplantation and Vaginal flap incorporation. On follow up, successful repair was defined as no urine leak after removal of catheter.
Results
Out of 73 patients undergoing robot assisted VVF repair at our institute, 33 were classified as complex VVF. Mean age was 42.7 ± 7.2 years. The most common cause of VVF was post hysterectomy (81.8%) with 21 (63.1%) recurrent VVFs. Thirty patients (90.0%) had supratrigonal fistulae; multiple fistulae were present in 3 cases. Two patients underwent Boari flap ureteric reimplantation for concomitant ureteric stricture and ureteric neocystostomy was required in another patient. One patient underwent our novel technique of vaginal flap incorporation and a Burch colposuspension was performed simultaneously in one patient with stress incontinence. The median follow-up was 35 months (IQR 8.5months). Successful outcome was noted in 31 (93.9%) patients; recurrence requiring further repair in 2 patients.
Conclusions
The current series presents the largest number of complex VVFs repaired by robotic assistance. Robot assisted repair can be considered as one stop procedure for such complex and vexing problems.
The Burch colposuspension has a 50-plus year history demonstrating strong long-term outcomes with minimal complications. Iterations of the procedure, including laparoscopic, robotic, and mini-incisional approaches, appear to have equal efficacy to the open procedure. Although the current use of the Burch colposuspension has waned with the growing shift toward sling surgery, it continues to have a role in the treatment of stress urinary incontinence. Specifically, a Burch procedure should be considered when vaginal access is limited, concurrent intra-abdominal surgery is planned, or mesh is contraindicated.
Introduction and hypothesis
The Burch colposuspension is a well-studied and proven surgical treatment for stress urinary incontinence without intrinsic sphincter deficiency. The advent of the minimally invasive mid-urethral sling has given rise to diminished surgical experience in performing the Burch. Recent anti-mesh media and FDA notifications have caused patients to demand mesh-free surgery, resulting in an opportunity for the resurgence of the Burch procedure. The objective of this video is to demonstrate surgical technique and instruction for a robotic Burch colposuspension as well as recommendations for successful completion of the procedure. Additionally, the video reviews and illustrates pertinent surgical anatomy regardless of approach.
Methods
The patient is a 53-year-old woman who presented with symptoms of vaginal pressure, urinary incontinence, and constipation. She had symptoms and urodynamics consistent with mixed urinary incontinence without intrinsic sphincter deficiency and had been treated with antimuscarinics for overactive bladder. On examination she was found to have stage II prolapse. She desired surgical management of both her prolapse and stress incontinence.
Conclusion
Robotic Burch colposuspension can be completed in a safe and effective manner and should be considered as an option for patients in whom an anti-incontinence procedure is indicated and who are already undergoing robotic surgery.
To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery.
Prospective observational study.
Tertiary referral urogynaecology unit.
Fifty-two consecutive women with recurrent genuine stress incontinence operated on by one surgeon.
Subjective and objective cure of stress incontinence. Complications of surgery.
The mean age of the women was 51 years (range 28-72) and weight 72.7 kg (range 53-112). Sixty-five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post-operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear which required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self-catheterisation, but only one needed to continue this for six months. None of the women developed detrusor instability.
In this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.