When I trained, most prolapse and stress urinary incontinence operations were done through the vagina. Still, there were many advocates for major abdominal incision procedures for these indications until recently. This is hard to believe.

Abdominal urogynecological and pelvic support operations were the preferred method of treatment based on training and remuneration. Laparoscopic and vaginal procedures are better. Why are there so few laparoscopic operations done today? It is a major problem! Gynecologists today are not trained to do laparoscopic surgery. Unfortunately they are not trained to do vaginal surgery, either! This poses an ethical dilemma. Are we offering the best choices to our patients?

Laparoscopic operations before 1986 were done with the operating surgeon visualizing the operative field with one eye with minimal assistance. Camran Nezhat popularized videolaparoscopy in 1985-1986. In 1988 no one except me was thinking about doing hysterectomy by laparoscopy. C Liu mastered curved needle suturing techniques in 1990 and immediately thereafter developed the laparoscopic Burch procedure. The ability to suture, popularized by Kurt Semm and Lilo Mettler, still defines the advanced laparoscopic surgeon. Today, the TOT procedure done vaginally is considered a major advance. But we still don't know the long-term effects of these mesh operations! Techniques both with and without mesh to prevent and correct pelvic floor disfunction are discussed in this book.

Please realize that publication of laparoscopic gynecological operations was very difficult until the mid 90s as few of the pioneers were in academic positions. Laparoscopic hysterectomy was unpublishable before 1988. Many papers of substance on laparoscopic surgery in the early 90s were in a journal that never got Index Medicus acceptance: Gynecological Endoscopy.

Nutan Jain has been a star during the development of advanced laparoscopic surgery. Her passion for laparoscopic surgery helped its development and assimilation around the world.

She has done much to develop minimally invasive surgery, but we have a long way to go. I look forward with great pleasure to reading the complete version of this volume.

With the pelvic floor anatomy now clear on high resolution two-dimensional or even three-dimensional viewing monitors, the gynecologist is able to develop greater proficiency in reconstructing female pelvic floor defects.

To help the gynecologist to gain familiarity with up-to-date laparoscopic, minimally invasive surgery in the field of urogynecology, Dr Nutan Jain has produced this outstanding textbook, Laparoscopic Management of Prolapse and Stress Urinary Incontinence, with a group of distinguished international contributors in presenting their expertise in surgical approaches to pelvic floor defects. As the population ages, disorders of the pelvic floor are encountered with increasing frequency, making this textbook a welcome addition to reference libraries of all gynecologists interested in staying abreast in the field of minimally invasive management of female organ prolapse and stress urinary incontinence.

This book has been crafted keeping in mind the need of every endoscopist. A group of dedicated endoscopic surgeons and urologists have toiled together to compile this atlas cum textbook which covers each and every aspect of minimally invasive management of prolapse and SUI. Not only has the text been written by world's leading experts, the surgical techniques too are shown through high quality pictures from actual surgeries.

The introduction emphasizes to the reader the core basic principles of laparoscopic management and how better delineation of support anatomy as visualized by the laparoscopic route been instrumental in bringing out superior repair deep in the pelvis. Since knowledge of anatomical landmarks and pelvic support structures are the hallmark for successful outcome of pelvic floor repair laparoscopic anatomy and pelvic support anatomy have been detailed in two chapters with the help of illustrations and surgical pictures of various anatomical spaces and important support structures in prolapse repair.

Grading of prolapse has always been a dilemma, so to bring at rest subjective and objective differences in gradation of prolapse the ICS (International Continence Society) has brought about new quantification system the POPQ test. Full chapter has been devoted to clearly explain the very new concept in a lucid manner. This promises to bring universality in measuring and treating various grades of prolapse.

Before any surgery for SUI, the preoperative evaluation by history, examination and urodynamic studies is essential and the foundation of good postoperative success. This issue is dealt in exquisite details.

All of us realize the might of good suturing skills. Aiming to improve suturing skills three chapters have been dedicated to Extracorporeal, Intracorporeal and Sliding Weston Knots.

We have devoted three chapters on management of SUI from world pioneers on TVT, the new transobturator slings (TOT) and an innovative trocar-assisted sling surgery, TASS. They are designed to apprise the reader of exact techniques pitfalls and results. Even with the advent of various sling procedures, Laparoscopic, Burch and Paravaginal repair remains a highly acclaimed surgery with longest follow-up, so we have devoted a full chapter to discuss the minute details.

Prevention is better than cure, keeping this in mind we have devoted a chapter to avoid posthysterectomy vault prolapse by employing HiMcall Culdoplasty as a routine. We have discussed the role of mesh, types of mesh, when to use, how to use to best advantage and short and long-term complications with use of mesh. With this background of anatomy, suturing and mesh dynamics we have several chapters highlighting various surgeries directed to surgical correction of pelvic organ prolapse. To highlight different modalities of surgical options we have the world's most renowned pioneers to highlight their innovative techniques. An average practitioner will find surgical options for all types of patients, young, elderly, wanting further child bearing, wanting to use mesh or not. Several different techniques have been described from which the reader can choose the one best suited for his or her own patient. No one surgical technique is applicable in all clinical situations so the reader can combine various techniques described by the pioneers, keeping his, 11her suturing capabilities and demands of clinical situations. Our endeavour has been to collectively give in one single textbook all, minimally invasive treatment options as practised today worldwide.

Keeping up with advancement in vaginal surgery we have included two chapters on reparative vaginal surgery, the old and new the time tested sacrospinous ligament suspension and the newer mesh augmented repair as popular today have all made way in this book.

Genitourinary fistulae though declining still are occasionally encountered and laparoscopic management has been discussed. Hope some of the readers would be able to convert their treatment approach when faced with these fistulae. Since all prolapse and SUI surgeries would need a cystoscopy during and after the procedure a chapter has been included to go in the core basic technique of cystoscopy for an average gyneendoscopic surgeon. Interstitial cystitis a cause of painful bladder with urgency, frequency is often encountered and creates a dilemma in final diagnosis of SUI. It remains largely undiagnosed with no definite treatment options. So we have a chapter discussing all these issues.

In a way in this book we have dealt with all aspects of urogyneology and prolapse repair pertaining to our day to day practice. Soon laparoscopic management of prolapse will be as accepted as Laparoscopic Hysterectomy today. Gradually critics will be fewer and aspirants for learning to treat will be more. Hope our vision of giving the very best to the readers is fulfilled and this atlas with its richness of text, references and high quality color photographs, seems to provide all. I was fascinated with laparoscopic management of pelvic floor disorders and bringing out an atlas cum textbook on this subject is the culmination of my cherished dream. Hope the readers enjoy going through it.

I express my heartfelt gratitude to all contributing authors, pioneers in their specific fields who despite their busy schedules put in their best efforts to compile chapters of immense scientific value. Their valuable suggestions, constructive criticism and words of encouragement during the compilation of the book went a long way in keeping me motivated towards this task. Their valuable contributions collectively has taken the shape of a fine textbook and atlas which will enlighten gynecologists and general surgeons practicing urogynecology and pelvic organ prolapse. I take this opportunity to express my sincere gratitude to all my teachers, who taught me, nurtured my skills and enabled me to work for the cause of Endoscopic Surgery.

I profusely thank the Publishers M/s Jaypee Brothers Medical Publishers (P) Ltd. and especially Shri Jitendar Pal Vij (CMD), Mr Tarun Duneja (General Manager Publishing) and their efficient team. They put in tremendous efforts to bring out this book timely and to give it excellent print and picture quality. It was a pleasant experience working with them.

My sincere, thanks to dear friends like Mrs and Dr Kame, Mrs and Dr Gada, Mrs and Dr Dilip Pal, Mrs and Dr Narayana Hegde, Mrs and Dr Sunil Ahuja, Mrs and Dr Satish Bhutani, and Mrs Shashi Dawar.

I am greatly thankful to all the doctors of my city who encouraged my academic pursuits. Practising in a small city I learnt the value of learning from seniors and giving one's best to juniors. It is their continued support, which has been instrumental in bringing out this book.

Most of the credit for the endoscopy imaging that has been central to the publication goes to Mr Aniruddha Nene, Director and Principal Consultant of M/s 21 Century Health Management Solutions Pvt Ltd. I thank his team specially Mr Kedar S Kadam for their valuable support.

I would like to acknowledge the efforts of Dr Aruna Arya and Dr Anuj who have been very keen on this project and helped me a lot in the compilation of this book. I sincerely thank my own hospital staff especially Mr Ashish, Vishram, Basu and Swati who have worked day and night for the compilation of this book. They deserve full credit for their excellent work and dedication.

I greatly appreciate the wholehearted support of all my family members. My parents have been a great source of inspiration for me. My husband Dr Mukesh and children, Mansi and Anubhav have in their capacity been extremely caring and helpful and never complaining about the lesser time spent with them. Their unwavering support helped me tide over the difficult phases during the compilation of this book.

In the end, I would like to thank all my patients who have posed faith in me and the newer modality of Laparoscopic Management of Prolapse and Stress Urinary Incontinence. If I can assure safe propagation of advanced endoscopic surgery for prolapse repair and SUI by means of this atlas. It will be the culmination of my dream to make the world a better place to live for the unfortunate sufferers of pelvic organ prolapse and SUI.