VINCENT R. LUCENTE, MD, MBA MILES MURPHY, MD Dr. Lucente is medical director of the Institute for Female Pelvic Medicine and Reconstructive Surgery in Allentown, Pa, and associate professor of clinical OBG, Pennsylvania State University College of Medicine, Hershey, Pa. Dr. Murphy is clinical instructor in the division of female pelvic medicine and reconstructive surgery, University of Louisville, Louisville, Ky.
The learning curve for laparoscopic Burch is steep and somewhat long—approximately 20 cases. The real question, therefore, is whether the benefits justify the time needed to master this procedure. In other words, is there clinical evidence that, once the plateau of this curve has been reached, we can reduce patient morbidity while maintaining efficacy compared to the traditional open technique? If not, there’s little reason for surgeons to learn the technique. If there is, however, more physicians should include the laparoscopic Burch in their surgical arsenal.
The real question is whether the benefits of the laparoscopic Burch justify the time needed to master the procedure.
When we limit the discussion to 2 comparable techniques, a laparoscopic versus open 2-suture procedure, there is moderately strong evidence that the laparoscopic approach maintains efficacy while modestly reducing morbidity.42 The strength of this evidence is established in 6 studies, including 3 randomized trials (level I evidence).8,18,23,24,43,44
Currently, data are insufficient regarding a laparoscopic approach to make concomitant site-specific defect repairs.45-51 However, if the procedures are performed in the same fashion, “suture for suture,” as their abdominal counterparts, we should expect to see, as we have with the laparoscopic Burch, similar efficacy rates between the laparoscopic and open approaches.
So, in closing, we encourage our colleagues to reignite their interest in learning laparoscopic reconstructive surgery and recommit to reaching that learning curve plateau. Why? We owe it to our patients.
Dr. Lucente is a consultant for GyneCare. Dr. Murphy reports no financial relationship with any companies whose products are mentioned in this article.
