Single incision vs TOT
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Transcript of Single incision vs TOT
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Single incision vs
MAURIZIO SERATIRicercatore Universitario - Clinica Ostetrica e Ginecologica
Università degli Studi dell’Insubria - Varese
TOT
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Invasiveness Complication rateClinical cure
WHAT IS THE GOLD-STANDARD?
It’s better to be tormented by
doubts, rather than run the risk of living
with the wrong conviction
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Why
?
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The pain experienced by the transobturatorroute may be reduced using newer products that aim to shorten the length of the tape and avoid mesh penetratingthe adductor muscles of the thigh
SINGLE INCISION
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APPROCCIO TRANSOTTURATORIO
TVT Single incision
TVT-O
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RETROPUBIC VS
TRANSOBTURATOR ?
TO-MUS VS RP-MUS
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vs
N Engl J Med 2010
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Retropubic vs Transobturator
N Engl J Med 2010
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Retropubic vs Transobturator
N Engl J Med 2010
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Retropubic vs Transobturator
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Retropubic vs Transobturator
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RETROPUBIC VS
TRANSOBTURATOR ?
TO-MUS VS RP-MUS
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TRANSOBTURATOR
TO-MUS VS RP-MUS
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E allora perché le single incision?
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Discontent is the first step towards
progress
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Ma quali sarebbero i
motivi di «discontent
»?
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PAIN
Tape types: which is the most painful tape?
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vs
PAIN
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The pain experienced by the transobturatorroute may be reduced using newer products that aim to shorten the length of the tape and avoid mesh penetratingthe adductor muscles of the thigh
PAIN
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1°-2°day 1° month
PAIN
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2014
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Subj
ectiv
e cu
re ra
te
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QOL
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• A trend towards higher rates of repeat continence surgery was noted in the SIMS group
• No studies on the SIMS with medium- or long-term follow.up exist
• Abdel-Fattah failed to demonstrate that the SIMS is associated with a lower complication rate in terms of voiding dysfunction, de novo OAB, vaginal erosion, or lower urinary tract injuries
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SINGLE INCISION VS TRANSOBTURATOR
E’ TUTTO COSÌ COMPLESSO
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2014
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SINGLE INCISION VS TRANSOBTURATOR
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2014
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SINGLE INCISION VS TRANSOBTURATOR2014
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Monarc MiniArc
vs
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E’ lo studio che riporta la più grande differenza in termini di dolore…
…MA…
perché SEMPRE OUT IN?
CLINICAMENTE PIU’ RILEVANTE DOLORE O DISAGIO PER VOIDING DYSFUNCTION?
OBSTET GYNECOL: ANCORA Più DUBBIO CLINICAMENTE RILEVANTE, NEMMENO
DIFFERENZA DI ANALGESICI
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INSIDE-OUT VS OUTSIDE-IN?
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2014
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2015
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SINGLE INCISION VS TRANSOBTURATOR
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Ma la TO causa davvero sempre
così tanto dolore?
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2015
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p = 0.01
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…CONCLUDENDO…
SINGLE INCISION VS TRANSOBTURATOR
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SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
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SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
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SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
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SINGLE INCISION VS TRANSOBTURATOR
MINOR DOLORE?
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SINGLE INCISION VS TRANSOBTURATOR
MINOR DOLORE?
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NESSUNA CERTEZZA…NULLA DI PARAGONABILE A RP VS TO
SINGLE INCISION VS TRANSOBTURATOR
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NON SEMPRE CIO’ CHE VIEN
DOPO E’ PROGRESSO
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A volte è meglio tacere e sembrare stupidi che aprire bocca e togliere ogni dubbioO.Wilde
Lago di Varese