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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