Stress urinary incontinence in women is a prevalent condition often treated with surgical interventions. Concerns over safety and efficacy of synthetic mid-urethral slings have led to a resurgence of interest in older techniques, including autologous pubovaginal slings. This study aims to present an innovative approach combining laparoscopic and vaginal surgery to address shortcomings associated with traditional slings.

The study proposes a novel surgical technique with two objectives. The primary objective is to assess the feasibility of harvesting grafts through minimally invasive means, specifically targeting the rectus abdominis posterior fascia at the supraumbilical level via laparoscopy. Secondary objectives include improving sling placement by reducing vaginal incision size, ensuring visual control throughout the procedure, and achieving mid-urethral positioning of the sling.

The described technique involves a combined laparoscopic and vaginal surgery approach. It requires a single patient positioning and port placement for both laparoscopic and vaginal phases of the surgery. The laparoscopic phase consists of a two-stage procedure involving harvesting of the rectus abdominis posterior fascia sling followed by minimal dissection of the Retzius space and Cooper's ligament. The vaginal stage entails small dissection under the mid-urethra, facilitating tension-free sling placement under both laparoscopic and vaginal visualization. The sling is anchored to the Cooper's ligaments, mimicking the anatomical path of retropubic mid-urethral slings.

This innovative approach demonstrates feasibility in achieving a minimally invasive mid-urethral autologous sling placement. While efficacy remains to be confirmed through prospective studies, this technique holds promise in offering favorable outcomes for stress urinary incontinence treatment, potentially offering the benefits of both retropubic synthetic mid-urethral slings and traditional autologous slings. Compared to autologous pubovaginal slings, this approach is anticipated to offer several advantages. These may include reduced short and long-term pain, improved outcomes regarding urgency and voiding difficulties, and potentially, cost-effectiveness due to its minimally invasive nature. Prospective studies are necessary to assess the efficacy, safety, and long-term outcomes of this approach comprehensively. Additionally, comparative studies against existing techniques will provide insights into its relative advantages and limitations. Through rigorous investigation, this innovative technique may eventually become a valuable addition to the armamentarium of treatments for stress urinary incontinence in women.

Continence 12S (2024) 101530
DOI: 10.1016/j.cont.2024.101530