This DVD was recorded in the Surgical Theater during an actual operation.
Daryoosh Samimi, M.D., FACOG
U.S. WOMEN INSTITUTE
BACKGROUND:
This is a report of a new technique and experience performing Outpatient Burch-Sling with
No Laparotomy or Laparoscopy as a Nerve Sparing Technique.
The purpose of this operation is to describe the surgical approach to
genuine stress urinary incontinence, which hopefully will prevent injuries
to somatic nerve fibers:
- External urethral sphincter nerve
- Dorsal nerve of clitoris
- Posterior nerve of labia majora
- Posterior nerve of labia minora, plus
- Vaginal nerves from autononilc nerve division
TECHNIQUE:
The procedure is a retropubic bladder neck suspension using our newly invented bladder
saver device. In this technique, the vagina is elevated bilaterally at the urethrovesical
junction. This repositions the proximal urethra within the abdominal cavity
toward Cooper’s Ligament with permanent sutures. In this method the vaginal
wall is used as an endogenous suburethral sling.
EXPERIENCE:
Fifty eight cases have been performed with no major
complications and only one who bad no improvement. Follow-up is
from six months to eight years. This minimally invasive outpatient
closed Burch-Sling Procedure, utilizing the bladder saver device,
allows performance of a time-proven operation with very little morbidity.
CONCLUSION:
There are many references in the medical literature relating to nerve injury due to surgery.
The likelihood of damage is greater during traditional incontinence procedures because of
extensive vaginal wall dissection. The unique features of our technique are:
1. May be done as an outpatient.
2. Absence of anterior vaginal wall dissection.
3. Use of an endogenous sling for colpo-urethiopexy.
4. Cooper’s Ligament is used to anchor the suspension sutures.
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This DVD was recorded in the Surgical Theater during an actual operation.
Daryoosh Samimi, M.D., FACOG
U.S. WOMEN INSTITUTE
Fed. Registration No. 2032647
Objective:
Create a relatively bloodless, nerve-sparing support of the pelvis without hysterectomy.
METHOD:
Many patients with Grade 4 uterovaginal prolapse underwent a simple procedure wherein
the endopelvic fascia cardinal uterosacral complex were raised up and anchored
toward the ileopectineal line “ligament and tendinous sheet”. The uterus was preserved in each case.
RESULTS:
Postoperative pain was minimal and hospital stay was significantly shortened.
massive uterovaginal prolapse is unacceptable to most who experience it.
CONCLUSION:
Quality of life was improved while sparing local nerve supply and preserving vaginal
and uterine function. A device, invented by the author, facilitated the performance
of the procedure and ensured correct placement of sutures. This technique can be
mastered by any competent Surgeon and should become “State of the Art”
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