Laparoscopy and Robotics in Stress Urinary Incontinence and Pelvic Reconstructive Surgery

  • Alvaro LucioniEmail author
  • Kathleen C. Kobashi
Part of the Current Clinical Urology book series (CCU)


The prevalence of pelvic floor disorders such as urinary incontinence and pelvic organ prolapse (POP) has seemingly increased over the last several decades. This increase could be attributed to longer life expectancy as well as the increased awareness of such disorders amongst health-care professional and patients. A recent epidemiological study found that the prevalence of at least one pelvic floor disorders among US women was 23.7% with the majority of them being affected by urinary incontinence [1]. Approximately 10% of women undergo surgery for treatment of urinary incontinence or POP. Thirty percent of these women will subsequently undergo one or more procedures after the first repair [2]. Proportionate to this increase in surgical management of pelvic floor disorders has been growth in the utilization of minimally invasive surgical treatments. Laparoscopic and robotic techniques allow surgeons to apply their open surgical skills in a minimally invasive fashion.


Stress urinary incontinence Pelvic organ prolapse Cystocele Rectocele Laparoscopic colposuspension Laparoscopic sacrocolpopexy Vesicovaginal fistula Laparoscopic augmentation cystoplasty 



Paul Kozlowski, MD, and David E. Rapp, MD, for their collaboration in the video preparation.

Supplementary material

Robotic Sacrocolpopexy (54.9 MB)


  1. 1.
    Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 17 Sep 2008;300(11):1311–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. Apr 1997;89(4):501–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9.PubMedGoogle Scholar
  4. 4.
    Rapp DE, Kobashi KC. The evolution of midurethral slings. Nat Clin Pract Urol. Apr 2008;5(4):194–201.PubMedGoogle Scholar
  5. 5.
    DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. Jun 1994;170(6):1713–20; discussion 1720–3.PubMedGoogle Scholar
  6. 6.
    Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Enhorning G. Simultaneous recording of intravesical and intra-urethral pressure. A study on urethral closure in normal and stress incontinent women. Acta Chir Scand Suppl. 1961;Suppl 276:1–68.PubMedGoogle Scholar
  8. 8.
    Burch JC. Cooper’s ligament urethrovesical suspension for stress incontinence. Nine years’ experience – results, complications, techniques. 1968. Am J Obstet Gynecol. Aug 2002;187(2):512; discussion 513.PubMedCrossRefGoogle Scholar
  9. 9.
    Frankel G, Kantipong M. Sixteen-month experience with video-assisted extraperitoneal laparoscopic bladder neck suspension. J Endourol. Jun 1995;9(3):259–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Raboy A, Hakim LS, Ferzli G, Antario JM, Albert PS. Extraperitoneal endoscopic vesicourethral suspension. J Laparoendosc Surg. Oct 1993;3(5):505–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper MJ, Cario G, Lam A, Carlton M. A review of results in a series of 113 laparoscopic colposuspensions. Aust N Z J Obstet Gynaecol. Feb 1996;36(1):44–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Wolf JS, Jr, Monk TG, McDougall EM, McClennan BL, Clayman RV. The extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery. J Urol. Sep 1995;154(3):959–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Persson J, Wolner-Hanssen P. Laparoscopic Burch colposuspension for stress urinary incontinence: a randomized comparison of one or two sutures on each side of the urethra. Obstet Gynecol. Jan 2000;95(1):151–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Zullo F, Palomba S, Russo T, et al. Laparoscopic colposuspension using sutures or prolene meshes: a 3-year follow-up. Eur J Obstet Gynecol Reprod Biol. 1 Dec 2004;117(2):201–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Dean NM, Ellis G, Wilson PD, Herbison GP. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2006;3:CD002239.PubMedGoogle Scholar
  16. 16.
    Khan MS, Challacombe B, Rose K, Dasgupta P. Robotic colposuspension: two case reports. J Endourol. Sep 2007;21(9):1077–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Phelps JY, Lin L, Liu CY. Laparoscopic suburethral sling procedure. J Am Assoc Gynecol Laparosc. Nov 2003;10(4):496–500.PubMedCrossRefGoogle Scholar
  18. 18.
    Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. Jul 1996;175(1):10–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Schaffer JI, Wai CY, Boreham MK. Etiology of pelvic organ prolapse. Clin Obstet Gynecol. Sep 2005;48(3):639–47.PubMedCrossRefGoogle Scholar
  20. 20.
    Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirth–elective caesarean section? Br J Obstet Gynaecol. Aug 1996;103(8):731–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Alperin M, Moalli PA. Remodeling of vaginal connective tissue in patients with prolapse. Curr Opin Obstet Gynecol. Oct 2006;18(5):544–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 13 Apr 2006;354(15):1557–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Anger JT, Raz S, Rodriguez LV. Severe cystocele: optimizing results. Curr Urol Rep. Sep 2007;8(5):394–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Ballert KN, Biggs GY, Isenalumhe A Jr, Rosenblum N, Nitti VW. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. Feb 2009;181(2):679–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Sand PK, Koduri S, Lobel RW, et al. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol. Jun 2001;184(7):1357–62; discussion 1362–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. Dec 2001;185(6):1299–304; discussion 1304–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn. 2008;27(1):3–12.PubMedCrossRefGoogle Scholar
  28. 28.
    Behnia-Willison F, Seman EI, Cook JR, O’Shea RT, Keirse MJ. Laparoscopic paravaginal repair of anterior compartment prolapse. J Minim Invasive Gynecol. Jul–Aug 2007;14(4):475–80.PubMedCrossRefGoogle Scholar
  29. 29.
    Daneshgari F, Paraiso MF, Kaouk J, Govier FE, Kozlowski PM, Kobashi KC. Robotic and laparoscopic female pelvic floor reconstruction. BJU Int. Sep 2006;98(Suppl 1):62–8; discussion 69.PubMedCrossRefGoogle Scholar
  30. 30.
    Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol. Dec 2004;104(6):1403–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Gadonneix P, Ercoli A, Salet-Lizee D, et al. Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse. J Am Assoc Gynecol Laparosc. Feb 2004;11(1):29–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Gadonneix P, Ercoli A, Scambia G, Villet R. The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol. Aug 2005;17(4):376–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Loffeld CJ, Thijs S, Mol BW, Bongers MY, Roovers JP. Laparoscopic sacrocolpopexy: a comparison of Prolene and Tutoplast mesh. Acta Obstet Gynecol Scand. 2009;88(7):826–30.PubMedCrossRefGoogle Scholar
  34. 34.
    Ganatra AM, Rozet F, Sanchez-Salas R, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 4 Feb 2009;55(5):1103–5.CrossRefGoogle Scholar
  35. 35.
    North C, Ali-Ross N, Smith A, Reid F. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG. 28 May 2009;116(9):1251–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Claerhout F, Roovers JP, Lewi P, Verguts J, De Ridder D, Deprest J. Implementation of laparoscopic sacrocolpopexy-a single centre’s experience. Int Urogynecol J Pelvic Floor Dysfunct. 29 May 2009;20(9):1119–25.PubMedCrossRefGoogle Scholar
  37. 37.
    Ayav A, Bresler L, Hubert J, Brunaud L, Boissel P. Robotic-assisted pelvic organ prolapse surgery. Surg Endosc. Sep 2005;19(9):1200–3.PubMedCrossRefGoogle Scholar
  38. 38.
    Daneshgari F, Kefer JC, Moore C, Kaouk J. Robotic abdominal sacrocolpopexy/sacrouteropexy repair of advanced female pelvic organ prolaspe (POP): utilizing POP-quantification-based staging and outcomes. BJU Int. Oct 2007;100(4):875–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol. Aug 2006;176(2):655–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Kramer BA, Whelan CM, Powell TM, Schwartz BF. Robot-assisted laparoscopic sacrocolpopexy as management for pelvic organ prolapse. J Endourol. Apr 2009;23(4):655–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. Jul 2001;11(4):417–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Sotelo R, Mariano MB, Garcia-Segui A, et al. Laparoscopic repair of vesicovaginal fistula. J Urol. May 2005;173(5):1615–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of five patients. Urology. May 2006;67(5):970–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. May 1994;83(5 Pt 2):899–901.PubMedGoogle Scholar
  45. 45.
    Melamud O, Eichel L, Turbow B, Shanberg A. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. Jan 2005;65(1):163–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Hasan ST, Marshall C, Robson WA, Neal DE. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. Br J Urol. Nov 1995;76(5):551–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Mundy AR, Stephenson TP. “Clam” ileocystoplasty for the treatment of refractory urge incontinence. Br J Urol. Dec 1985;57(6):641–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Meng MV, Anwar HP, Elliott SP, Stoller ML. Pure laparoscopic enterocystoplasty. J Urol. Mar 2002;167(3):1386.PubMedCrossRefGoogle Scholar
  49. 49.
    Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 15 Jul 1971;110(6):886–7.PubMedGoogle Scholar
  50. 50.
    Gill IS, Rackley RR, Meraney AM, Marcello PW, Sung GT. Laparoscopic enterocystoplasty. Urology. Feb 2000;55(2):178–81.PubMedCrossRefGoogle Scholar
  51. 51.
    Noguera RJ, Astigueta JC, Carmona O, et al. Laparoscopic augmentation enterocystoplasty through a single trocar. Urology. Jun 2009;73(6):1371–4.PubMedCrossRefGoogle Scholar
  52. 52.
    El-Feel A, Abdel-Hakim MA, Abouel-Fettouh H, Abdel-Hakim AM. Laparoscopic augmentation ileocystoplasty: results and outcome. Eur Urol. 7 Apr 2008;55(3):721–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Cheon WC, Mak JH, Liu JY. Prospective randomised controlled trial comparing laparoscopic and open colposuspension. Hong Kong Med J. Feb 2003;9(1):10–4.PubMedGoogle Scholar
  54. 54.
    Ankardal M, Ekerydh A, Crafoord K, Milsom I, Stjerndahl JH, Engh ME. A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. BJOG. Sep 2004;111(9):974–81.PubMedCrossRefGoogle Scholar
  55. 55.
    Kitchener HC, Dunn G, Lawton V, Reid F, Nelson L, Smith AR. Laparoscopic versus open colposuspension–results of a prospective randomised controlled trial. BJOG. Sep 2006;113(9):1007–13.PubMedCrossRefGoogle Scholar
  56. 56.
    Carey MP, Goh JT, Rosamilia A, et al. Laparoscopic versus open Burch colposuspension: a randomised controlled trial. BJOG. Sep 2006;113(9):999–1006.PubMedCrossRefGoogle Scholar
  57. 57.
    Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. Aug 2005;112(8):1134–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Rozet F, Mandron E, Arroyo C, et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol. Feb 2005;47(2):230–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Ross JW, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol. May–Jun 2005;12(3):221–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Agarwala N, Hasiak N, Shade M. Laparoscopic sacral colpopexy with Gynemesh as graft material–experience and results. J Minim Invasive Gynecol. Sep–Oct 2007;14(5):577–83.PubMedCrossRefGoogle Scholar
  61. 61.
    Rivoire C, Botchorishvili R, Canis M, et al. Complete laparoscopic treatment of genital prolapse with meshes including vaginal promontofixation and anterior repair: a series of 138 patients. J Minim Invasive Gynecol. Nov–Dec 2007;14(6):712–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Sarlos D, Brandner S, Kots L, Gygax N, Schaer G. Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome—a prospective study with 101 cases. Int Urogynecol J Pelvic Floor Dysfunct. Oct 2008;19(10):1415–22.PubMedCrossRefGoogle Scholar
  63. 63.
    Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol. May 2005;192(5):1752–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.The Continence Center at Virginia Mason Medical CenterSeattleUSA
  2. 2.Section of Urology and Renal Transplantation, Department of UrologyUniversity of Washington, Virginia Mason Medical CenterSeattleUSA

Personalised recommendations