ENDOSCOPIC COLPOSUSPENSION (RETZIUSSCOPY VERSUS LAPAROSCOPY) - A MEANINGFUL EXTENSION OF THE SURGICAL SPECTRUM OF STRESS-INCONTINENCE

Within the framework of ''minimal access surgery'' a prospective rando mised study was initiated at the Dept. of Obstetrics and Gynaecology o f Heidelberg University to examine the feasibility of endoscopical abd ominal Burch colposuspension for stress incontinence (II-III), at lapa roscopy and ''retziusscopy''. Further, also prospectively randomised, two suspension techniques: needle suspension and suspension by means o f alloplastic material with stapler fixation, were compared, irrespect ive of the endoscopic approach chosen, especially because long-term re sults of our study population on colposuspension with fibrin glue whic h are now available, are below expectations, worse than those obtained with conventional techniques. Except for a bladder lesion (during lap aroscopic dissection of the space of Retzius) no intra- or postoperati ve complications occurred in the pilot study group of 20 patients. Bot h types of endoscopic access proved technically feasible, and presente d the typical advantages of minimal access surgery such as short hospi talization and rapid recovery. Short-term follow-up (2-12 months) show ed subjective and objective results (continence in 18/20 patients), co mparable to conventional abdominal procedures at laparotomy. Detailed evaluation of subgroups is not yet possible, since the number of patie nts it still too small and follow-up too short.