Download tot procedure

 TVT PROCEDURE
–
TOT PROCEDURE
 TOT helicoidal needle
 TOT semi-circular needle
TVT needle
 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.
 TOT POSITION OF THE MESH
 TYPES OF APPROACHES:
TOT – TransObturatorTape ( IN
TOT – TransObturatorTape ( OUT
OUT technique)
IN technique)
 out-in TOT PROCEDURE (most common)
• 2 cm anterior vaginal wall incision
• Periurethral scissor dissection.
 out-in TOT PROCEDURE
• Area of groin incision located
1 cm inferior to the Adductor
Longus Tendinous insertion,
at the level of clitoris.
 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.
 out-in TOT PROCEDURE
• The needle passed through the groin incision, through the
Obturator membrane and muscles and brought into the
vaginal incision.
 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
needle’s hole.
 out-in TOT PROCEDURE
• The needle with the attached thread of the mesh is then
brought back through the groin incision.
 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.
 out-in TOT PROCEDURE
• Excess mesh is cut off at
the groin incisions and
these are closed with
steri-strips.
• Vaginal incision is closed.
 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.
 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.