How to Apply Transobturator and Transvaginal Tape Needles for Stress Urinary Incontinence: A Cadaveric Demonstration
Article Language: EN
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Objective: This review aimed to demonstrate a proper method to perform transobturator and transvaginal tape needle (trocar) insertion with a cadaveric demonstration. Material and Methods: In April 2017, at Prof. Rhoton Anatomy Laboratory, Bahcesehir University, the cadaveric workshop of Pelvic Reconstructive and Functional Urology Surgery, an advanced masterclass on anatomy and surgery using fresh frozen cadavers was held. During the course, transobturator tape (TOT) and transvaginal tape (TVT) procedures were performed on a cadaveric model with a detailed dissection of anatomic landmarks. The course of the obturator artery and obturator nevre is extremely crucial during TOT operation. Moreover, the pathway of the TOT needle should be accurately known by the surgeons. However, during TVT operations, the surgeons should have precise hand movements to decrease the complication rates. Results: Cadaveric dissection courses in surgical education are highly crucial. A detailed knowledge of anatomic landmarks with pertinent structures, demonstration of surgical techniques, and discussion on potential complications improve surgical skills. After passing the skin, TOT needle passes just beneath the adductor longus tendon and through the obturator externus muscle, obturator membrane, obturator internus muscle, and periurethral endopelvic fascia and comes out from the vaginal incision. During this course, the most common complication is the injury of the obturator nerve or its branches; therefore, some patients complain about neuropathy after the operation. However, for the TVT operation, the risk of vascular, bowel, or bladder injury is higher than the TOT operation. Conclusion: This pictorial review demonstrates a proper method to perform the basic steps of TOT (Outside-In method) and TVT procedures with a cadaveric dissection.
Keywords: Anatomy; cadaver; suburethral slings; stress urinary incontinence; education