A NEW METHOD FOR LAPAROSCOPIC ACCESS TO THE SPACE OF RETZIUS DURING RETROPUBIC CYSTOURETHROPEXY

Purpose: We assessed the feasibility of a new technique for laparoscop ic dissection of the space of Retzius. Materials and Methods: In 10 wo men 40 to 70 years old (median age 45) undergoing laparoscopic retropu bic cystourethropexy for stress urinary incontinence hydrodissection w as used to create a pneumo-subperitoneal space. A suction irrigator pr obe was inserted into a mid peritoneal incision created with a 5 mm. t rocar above the symphysis pubis between the 2 umbilical ligaments. The subperitoneal space was developed and insufflated with carbon dioxide without incising the peritoneum. Results: All procedures were complet ed laparoscopically without intraoperative or postoperative complicati ons. Operative time for cystourethropexy ranged from 30 to 70 minutes (median 40). Estimated blood loss ranged from less than 50 to 300 ml. (median 100). Patients were discharged from the hospital within 24 to 48 hours. All patients reported satisfactory relief of symptoms at 3 t o 6 months of followup. Conclusions: The new technique is not difficul t and may minimize tissue injury. Pneumosubperitoneal pressure provide s clear exposure of the space of Retzius with minimal bleeding.