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.