Surgical technique:
We describe a novel technique of laparoscopic mid-urethral autologous
rectus fascial sling insertion (LMAFS) under laparoscopic guidance using
rectus sheath fascia in managing stress urinary incontinence. 4 cm
transverse lower abdominal incision is made and a strip of rectus fascia
is harvested measuring 6x2 cm (Figure 1). The small wound is then
closed. A sling on a string is then formed using permanent suture
material, which are sutured to both ends of the sling. A vaginal
incision is made 1.5 cm from the external urethral meatus. Para urethral
tunnels are then created with dissecting scissors. After routine
laparoscopic entry with two accessory ports, the retropubic space is
opened and the bladder is dissected down. The endopelvic fascia is then
perforated under laparoscopic guidance either side of the urethra with
scissors (Figure 2). The sutures on the end of the sling are then passed
into the retropubic space, and sutured to the Coopers ligaments after
tension-free adjustment of the sling under the mid urethra. The vaginal
skin is then closed with interrupted absorbable sutures and cystoscopy
is performed to check bladder and urethral integrity.