Extracorporeal Ligation Using Self-Made Knot Pusher in Laparoscopic Bladder Neck Suspension for Female Stress Urinary Incontinence

Kim, Yong Woo; Lee, Jeong Gu

Abstract

PURPOSE: Extracorporeal ligation using knot pusher enables one to tie surgical knots easily. However, commercialized knot pusher can not prevent the leakage of gas along the working port during procedure. So, we made knot pusher by ourselves which has a thick diameter enough to prevent leakage of CO2 gas and evaluated the usefulness of self-made knot pusher.
MATERIALS AND METHODS
Between May 1995 and May 1996, 28 women with anatomic SUI underwent laparoscopic BNS at our department. Of the total, 10 patients underwent laparoscopic BNS using commercialized knot pusher with a diameter of 3 mm (thin knot pusher group); whereas 18 underwent operation using self-made knot pusher with a diameter of 5 mm (thick knot pusher group). Laparoscopic BNS was done by extraperitoneal approach in all cases.
RESULTS
Patient`s characteristics of the 2 groups were similar. 25 of patients were exhibited grade 1 or 2 of incontinence at physical examinations, 10 in thin knot pusher group and 15 of 18 patients in thick knot pusher group. Urethral hypermobility (mean 52 degree) were observed in all cases by the Q-tip test. VLPP was far above 60 cmH2O at 150 ml filling in all cases. Mean operation time was 185 min in thin knot pusher group and 95min in thick knot pusher group. Post operative blood transfusion was needed in 2 cases (1 case for each group). Urethral catheter were removed 25 hours after the operations and return to normal voiding were possible in 27-29 hours without intergroup difference. Mean duration of hospital stay was 3 days in both group. Amount of residual urine at discharge was less than 100 cc in 28 cases (9 in thin knot pusher group and 19 in thick knot pusher group). Complication included 1 case recurrent urinary incontinence in thin knot pusher group, 1 case of voiding difficulty for each group (which were improved by medication and dean intermittent catheterization), 2 cases of frequency for each group (improved by medication), and 1 case of bleeding in thin knot pusher group(managed by laparoscopic coagulation and hematoma removal). 27 patients were completely dry at followup of 2-12 months following surgery. Only one patient with thin knot pusher group are still wet.
CONCLUSIONS
It was evident from this study that tying of knot using knot pusher thick enough to seal the lumen of working port prevented leakage of gas and therefore, shortened the total operation time.