TVT PROCEDURE

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• TVT PROCEDURE TOT
  PROCEDURE

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• TOT helicoidal needle
• TOT semi-circular needle

TVT needle
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• TOT POSITION OF THE MESH
• The mesh is placed under the mid-urethra
  and the tips of the mesh come out from the body
  through the Obturator foramen.

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• TOT POSITION OF THE MESH

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• TYPES OF APPROACHES
• TOT TransObturatorTape ( IN OUT
  technique)
• TOT TransObturatorTape ( OUT IN
  technique)

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• out-in TOT PROCEDURE (most common)
• 2 cm anterior vaginal wall incision
• Periurethral scissor dissection.

Step 1
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• out-in TOT PROCEDURE
• Area of groin incision located
• 1 cm inferior to the Adductor
• Longus Tendinous insertion,
• at the level of clitoris.

Step 2
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• out-in TOT PROCEDURE
• To guide the needle, the finger
• is placed in the vaginal incision.
• The needle is placed in the groin
• incision and then passed through
• it.

Step 3
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• out-in TOT PROCEDURE
• The needle passed through the groin incision,
  through the Obturator membrane and muscles and
  brought into the vaginal incision.

Step 4
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• out-in TOT PROCEDURE
• Once the needle is brought into the vaginal
  incision, it is connected to the tip of the mesh
  inserting the threads in the needles hole.

Step 5
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• out-in TOT PROCEDURE
• The needle with the attached thread of the mesh
  is then brought back through the groin incision.

Step 6
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• out-in TOT PROCEDURE
• The needle and the mesh is
• passed on the opposite side.
• Tape is then adjusted with an
• intra-operative cough test and
• adjusted until no leakage occurs.

Step 7
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• out-in TOT PROCEDURE
• Excess mesh is cut off at
• the groin incisions and
• these are closed with
• steri-strips.
• Vaginal incision is closed.

Step 8
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• TOT PROCEDURE IN-OUT
• Exactly the same as TOT OUT-IN procedure but the
  introduction of the needle is made from the
  vaginal incision to the groin incision, instead
  of the contrary.
• The needle used for this technique are
  semi-circular.

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• TVT PROCEDURE
• The needles are passed from the vaginal incision
  lateral to the urethra, following the posterior
  wall of the pubis, and crossing the fascia and
  the rectus muscle until the needle appears at the
  lower abdominal wall.
• The sling is adjusted and the excess mesh cut of.