The Burch procedure
is particularly useful when combined with other laparoscopic or open repairs such as bilateral tubal ligation, hysterectomy, and sacral colpopexy, as well as in younger women who wish to maintain fertility, in women with a history of mesh complications or allergies, and in women who wish to avoid foreign materials, Dr.
A surgeon doing nothing but laparoscopic Burch procedures could handle four cases, generate 50 RVUs, and bill for $15,188, Dr.
Incontinence cure rates probably are equivalent with laparoscopic Burch procedures, open Burch procedures, or TVT procedures, though more data from randomized controlled trials are needed to be sure, he said.
One of the touted advantages of laparoscopic Burch procedures for stress incontinence--faster recuperation--may in fact be a detriment, according to Dr.
The three cost-comparison studies done to date suggest that hospital costs for laparoscopic Burch procedures may be as high or higher than with the open Burch, largely because ofthe specialized equipment required.
Early glowing reports of terrific success rates with laparoscopic Burch procedures were flawed by a lack of preoperative assessment.
On the other hand, cystoscopy may be useful for detecting injuries if a Burch procedure is being performed along with other gynecologic surgical procedures, he said.
Rou tine intraoperative cystoscopy to identify lower urinary tract in juries caused during Burch procedures adds time and expense and is not warranted, Dr.
Earlier results of laparoscopic Burch procedures have been more equivocal because many of the techniques used were not conventional Burch techniques.
Ross said that more surgeons are currently performing laparoscopic Burch procedures to repair GSUI, compared with 5 years ago, the majority of surgeons are still doing them via laparotomy, largely because of the difficulty in being able to suture laparoscopically.
Since the HMOs I deal with pay quite a bit less than the amounts he mentioned, I would like to know where TVT and Burch procedures
are reimbursed at such high rates.