E-ISSN: 2619-9467

Contents    Cover    Publication Date: 28 Mar 2019
Year 2019 - Volume 29 - Issue 1

Open Access

Peer Reviewed

ORIGINAL RESEARCH
3124 Viewed1928 Downloaded

How to Apply Transobturator and Transvaginal Tape Needles: A Cadaveric Demonstration Study with Anatomical Landmarks

Full Text PDF  
J Clin Obstet Gynecol. 2019;29(1):17-23
DOI: 10.5336/jcog.2018-62806
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: This study aimed to demonstrate a proper method of performing transobturator tape (TOT) and transvaginal tape (TVT) needle (trocar) insertion with anatomical landmarks on a cadaver. Material and Methods: In April 2017, at Prof. Rhoton Anatomy Laboratory, Bahcesehir University, Istanbul/Turkey, 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, outside-in method) and transvaginal tape (TVT, bottom-to-top method) procedures were performed on a cadaveric model with a detailed dissection of anatomical landmarks. Results: After passing the skin, TOT needle passes just beneath the adductor longus tendon and through the gracilis tendon, adductor brevis tendon, obturator externus muscle, obturator membrane, obturator internus muscle, and endopelvic fascia, so comes out from the vaginal incision. During this course, there was a risk of injury to the obturator nerve. The average distance of TOT needle to the obturator nerve was found 1.9cm. However, for the TVT operation, the risk of vascular, bowel, or bladder injury was higher than the TOT operation because of the retropubic pathway. The average distance of TVT needle to the obturator neurovascular bundle at the retropubic space was found 3.4 cm. Conclusion: Performing the TOT and TVT needle insertions properly with correct hand movements and anatomical knowledge of neighbouring structures will decrease the risk of complications.
REFERENCES:
  1. Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367(9504):57-67.  [Crossref]
  2. Williams ER, Klutke CG. Stress urinary incon- tinence: the evolution of the sling. Expert Rev Med Devices. 2008;5(4):507-23. [Crossref]   [PubMed]
  3. Arici B,  Pulatoğlu C, Temizkan  O, Dogan O, Asicioglu O, Abike  F. The effects  of outside- in versus  inside-out transobturator tapes,  for stress urinary  incontinence, on sexual  function and quality of  life: a prospective  study. JCOG. 2018;28(2):52-9. [Crossref]
  4. Labrie J, Lagro-Janssen AL, Fischer K, Bergh- mans LC, van der Vaart CH. Predicting who will undergo surgery after physiotherapy for fe- male stress urinary incontinence. Int Urogy- necol J. 2015;26(3):329-34. [Crossref]  [PubMed]
  5. Anger JT, Weinberg AE, Albo ME, Smith AL, Kim JH, Rodriguez LV, et al. Trends in surgi- cal management of stress urinary inconti- nence among female Medicare beneficiaries. Urology. 2009;74(2):283-7. [Crossref]  [PubMed]  [PMC]
  6. Richter HE,  Albo ME, Zyczynski  HM, Kenton K, Norton  PA, Sirls LT,  et al. Retropubic  ver- sus transobturator  midurethral slings for  stress incontinence. N Engl  J Med. 2010;362(22): 2066-76. [Crossref]  [PubMed]  [PMC]
  7. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7: CD006375. [Crossref]
  8. Siccardi MA,  Valle C. Anatomy,  Bony Pelvis and Lower  Limb, Pelvic Fascia.  StatPearls. Treasure Island (FL); 2019.
  9. Delancey JL. True pelvis, pelvic floor and per- ineum. In: Standring S, ed. Gray's Anatomy: the Anatomical Basis of Clinical Practice. 41 st ed. New York: Elsevier; 2016. p.1221-37.
  10. Whiteside JL, Walters MD. Anatomy of the ob- turator region: relations to a trans-obturator sling. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(4):223-6. [PubMed]
  11. Spinosa JP,  Dubuis PY, Riederer  B. [Tran- sobturator surgery  for female urinary  conti- nence: from outside  to inside or  from inside to outside: a comparative  anatomic study]. Prog Urol. 2005;15(4):700-6. [PubMed]
  12. Hinoul P,  Vanormelingen L, Roovers  JP, de Jonge E,  Smajda S. Anatomical  variability in the trajectory  of the inside-out  transobturator vaginal tape technique  (TVT-O). Int Urogy- necol J Pelvic  Floor Dysfunct. 2007;18(10): 1201-6. [Crossref]  [PubMed]
  13. Bonnet P, Waltregny D, Reul O, de Leval J. Transobturator vaginal tape inside out for the surgical treatment of female stress urinary in- continence: anatomical considerations. J Urol. 2005;173(4):1223-8. [Crossref]  [PubMed]
  14. Huri E, Ezer M, Aydoğan B, Tatar I, Sargon MF. Anatomic transobturator tape (TOT) tech- nique: clinical anatomic landmarks of obtura- tor foramen on female cadavers. Anatomy. 2015;9(1):38-41. [Crossref]
  15. Karram MM. Synthetic midurethral slings for the correction of stress incontinence. In: Bag- gis MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2015. p.58.9.
  16. Jaburek L,  Jaburkova J, Lubusky  M, Proc- hazka M.  Risk of haemorrhagic  complications of retropubic surgery  in females: anatomic  re- marks. Biomed Pap  Med Fac Univ  Palacky Olomouc Czech Repub.  2011;155(1):75-7. [Crossref]  [PubMed]
  17. Selçuk İ,  Tatar İ, Fırat  A, Huri E,  Güngör T.  Is corona mortis a  historical myth? A  perspective from a gynecologic  oncologist. J Turk  Ger Gy- necol Assoc.  2018;19(3):171-2. [Crossref]  [PubMed]  [PMC]
  18. Cox A, Herschorn S, Lee L. Surgical man- agement of female SUI: is there a gold stan- dard? Nat Rev Urol. 2013;10(2):78-89. [Crossref]  [PubMed]
  19. Keltie K, Elneil S, Monga A, Patrick H, Powell J, Campbell B, et al. Complications following vaginal mesh procedures for stress urinary in- continence: an 8 year study of 92,246 women. Sci Rep. 2017;7(1):12015. [Crossref]  [PubMed]  [PMC]
  20. Biardeau X, Zanaty M, Aoun F, Benbouzid S, Peyronnet B. [Approach and complications as- sociated with suburethral synthetic slings in women: systematic review and meta-analy- sis]. Prog Urol. 2016;26(4):254-69. [Crossref]  [PubMed]
  21. Tommaselli GA, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incon- tinence: a systematic review and metaanaly- sis. Int Urogynecol J. 2015;26(9):1253-68.  [Crossref]  [PubMed]