An Underutilized Technique: The Robotic Burch Colposuspension

Abstract Purpose To describe our approach to an underutilized technique, the robotic Burch Colposuspension Introduction In 2019, the FDA recalled the use of transvaginal mesh for pelvic organ prolapse procedures.1 Following this announcement, the use of urethral slings also fell out of favor while procedures such as autologous fascial sling and colposuspensions became more popular as women and practitioners alike were seeking alternative SUI treatment options. The mid urethral sling (MUS) is currently the gold standard for the management of stress urinary incontinence. The MUS is both safer and more effective than a Burch Colposuspension2. For those that do not desire mesh, or have failed a prior procedure, the Burch Colposuspension remains a useful procedure3. The Robotic Burch is a minimally invasive, quick, and easy to perform procedure. Disadvantages of Burch Colposuspension may include cost, increased operative time, and potential lack of availability in ambulatory settings. Materials and Methods The Da Vinci Xi system is utilized with a 3 or 4 port configuration. An 8mm camera trocar is placed in the umbilicus. An 8mm trocar is placed 8cm laterally on each side of the camera port. In a 4 port configuration, the #4 8mm trocar is placed 8cm laterally to the #3 arm. If an assistant port is desired, this can be placed 8cm laterally to the #1 arm, at least 2cm above the anterior superior iliac spine (ASIS). A Fenestrated Bipolar Forceps is utilized in the #1 arm. A Monopolar Scissors is utilized in the #3 arm. A Prograsp Forceps is utilized in the #4 arm in a 4 port configuration. The patient is placed in a steep Trendelenburg position. Results A successful robotic colposuspension with a duration of less than 60 minutes total operation is performed. Conclusion The Robotic Burch Colposuspension is a minimally invasive procedure to manage stress urinary incontinence in those that do not desire a MUS, or have failed it. The Robotic Burch is a quick, easy, and minimally invasive approach to manage SUI.