Robotic Burch Colposuspension for Stress Urinary Incontinence

I can teach laparoscopic surgery in one to two months to any doctor or surgeon who wants to travel to India — I can generate good surgeons, and at least my students say I'm a good teacher. For the financial and logistical side of a patient's journey, that's where Jivo's team comes in: share the case with us, and even before a patient decides to travel, the hospital can give a tentative cost estimate to work from.

The ‘recurrence’ there refers to regain of body weight, not recurrence of disease. It happens when the patient's lifestyle doesn't change after surgery — the sleeve gradually dilates over time, though the stomach never reverts to its original size. When that happens, we convert the sleeve into a mini gastric bypass, and the patient starts losing weight again.

Think of it like Formula One racing — an F1 driver put on a city road will crash everywhere, and a city driver put on an F1 track won't know how to handle it. Every surgical approach needs specific training, and with the right training complications are very few. The key criterion is size: if the thyroid nodule or lobe is under 6 centimetres, I do it robotically or laparoscopically; above that, I advise open surgery regardless of cosmetic preference. In every case I identify the recurrent laryngeal nerve on both sides and all four parathyroid glands before removing the thyroid — the rule is, don't touch what you haven't seen.

The two have a complementary role, not a replacement one. Weekly injectable GLP-1 drugs aren't a permanent cure, and if a patient's BMI is above 45 or 50, injections alone won't take them from 150 kg to 75 kg — that needs a definitive, more durable intervention. But if someone just wants to go from 100 kg to 85 kg, injections are the right option and no surgery is needed. I sometimes even use GLP-1 injections for two to three months before surgery, to bring a patient's BMI down to a level the anaesthesiologist is comfortable with — so the two approaches often work together.

In females the urethra is only about 4 centimetres long, and incontinence happens when the internal urethral meatus — where the urethra meets the bladder — sags downward and loses muscular control. My job is to lift that junction back into its correct anatomical position, using a procedure called Burch colposuspension: three sutures on each side of the urethra along the anterior vaginal wall, lifted and fixed to Cooper's ligament. Doing this robotically lets me suture in that very narrow retropubic space with far more precision than laparoscopically. The surgery takes about an hour and the patient goes home happily the next day.

It happens when the internal urethral meatus, the junction where the roughly 4cm urethra meets the bladder, sags downward and loses the muscular control that normally keeps it closed.

Three sutures on each side of the urethra along the anterior vaginal wall, then lifted and fixed to Cooper's ligament.

It takes advantage of wrist precision to suture accurately in the narrow retropubic space, achievable with far greater precision robotically than laparoscopically.

The surgery takes about an hour, and patients typically go home the following day.