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TECHNIQUES FOR TECHNIQUES FOR RETROPUBIC, RETROPUBIC, TRANSOBTURATOR, & TRANSOBTURATOR, & SINGLE INCISION SLINGSSINGLE INCISION SLINGS
MICKEY KARRAM MDDIRECTOR OF UROGYNECOLOGY
THE CHRIST HOSPITALPROFESSOR OF OB/GYN & UROLOGY
UNIVERSITY OF CINCINNATI
CURRENTLY AVAILABLE CURRENTLY AVAILABLE SYNTHETIC SLINGSSYNTHETIC SLINGSRETROPUBIC; below to above vs above to
belowPREPUBICTRANSOBTURATOR; outside in vs inside
outMINI-SLING; urogenital diaphragm vs
obturator internusHOMEMADE SYNTHETIC SLINGS
GENUINE STRESS INCONTINENCE
ANATOMIC ISD
Suspend or Support
Obstruct
SPECTRUM OF DISEASE
BACKGROUND OF TVTBACKGROUND OF TVT
ULMSTEN & PETROS
1. INVENTOR OF PROCEDURE
2. PROPOSED INTEGRAL THEORY
3. CHALLENGED CURRENT THEORIES
Ischiopubic Ramus
Ischium
Pubic symphysis
IliumObturator
Foramen
Obturator
Canal
Transobturator LandmarksTransobturator Landmarks
Obturator canal
Urethra
SAFE ENTRY ZONE of NEEDLE
Adductor longus
Reiffenstuhl ,Platzer & Reiffenstuhl ,Platzer & KnapsteinKnapstein
Mesh PositionMesh PositionTVT
Synthetic Midurethral SlingsSynthetic Midurethral Slings
Third Generation MINI-SLINGSling is much shorter Requires only a small vaginal incision
No exit points
GYNECARE TVT SECUR System GYNECARE TVT SECUR System Mesh ImplantMesh Implant
The same proprietary PROLENE* polypropylene Mesh used for other GYNECARE TVT family of products7 years of clinical data on the meshConsists of a 1.1 cm x 8 cm PROLENE MeshLaser cut instead of mechanically cut with a knife or blade
MiniArc™ Single-Incision Sling MiniArc™ Single-Incision Sling SystemSystem MiniArc is a new procedure for SUI
that is:Less Invasive
◦ Requires only one incision, resulting in less dissection
◦ Not necessary to perforate obturator membrane
Designed for Efficacy◦ Same materials and similar sling
trajectory as Monarc®◦ Sling delivery tool that maximizes
safety and consistency of supportEasy to Perform
◦ Unique, simple design that is intuitive to use
Solyx SlingSolyx Sling
Ajust SlingAjust Sling
Single Incision MinislingsSingle Incision Minislings
PERCEIVED ADVANTAGES Minimal post-operative retention or
voiding dysfunction requiring interventionNo bladder or urethral injuryNo vascular injuryNo nerve injuriesNo erosions or excrusionsCan be done under local anasthesia or
with very minimal sedationAllows more objective utilization of cough
stress test
Single Incision MinislingsSingle Incision Minislings
PERCEIVED ADVATAGES (cont)Minimal to no postoperative painHAS BEEN SUCCESSFUL IN SEVERE ISD
PATIENTS WILL BECOME VERY POPULAR IF
REIMBURSEMENT CODES FOR OFFICE PLACEMENT ARE CREATED
Technical Points Unique to the Technical Points Unique to the Synthetic Midurethral SlingsSynthetic Midurethral Slings
Vaginal IncisionDirection of Insertion DeviceDepth of InsertionTensioning of Sling
Cadaver shootCadaver shoot
Cadaver TVTCadaver TVT
GunkelGunkel
AMS MiniarcAMS Miniarc
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