| July 2003 · Vol. 15, No. 7 SURGICAL TECHNIQUES
New transobturator sling reduces risk of injury
By placing the tension-free sling between the 2 obturator foramens using a perineal approach, surgeons can eliminate complications that stem from passing needle carriers through the retropubic space. Here, 2 experts delineate this easily learned technique.
MARCO
A.
PELOSI
II,
MD;
MARCO
A.
PELOSI
III,
MDDr. Pelosi II is director and Dr. Pelosi III is associate director of the Pelosi Women’s Medical Center,
Bayonne, NJ.
Videotapes and preceptorships are available from the authors.
Address correspondence to: Pelosi Women’s Medical Center, 350 Kennedy Boulevard, Bayonne, NJ 07002; telephone 201-858-1800; fax 201-858-1002; e-mail: mpelosi@aol.com
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KEY POINTS
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The route of the transobturator sling is strictly perineal, with a very short, blind passage through the crural region. This pathway ensures that the retropubic space is not entered and that the anatomic structures crossed by the needle passer and mesh are either muscle or fascia.
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The transobturator approach eliminates the need for routine cystoscopy in most patients.
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Short-term efficacy of the transobturator sling is similar to that of other suburethral tension-free slings.
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In our experience, the transobturator approach reduces average operating time to 17 minutes.
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Potential complications associated with passing needle carriers through the retropubic space are eliminated, and cystoscopy is not routinely required with the use of a transobturator sling.
Although it is effective and easy to perform,1-6 retropubic placement of suburethral tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence has been associated with a number of bowel, vascular, nerve, and bladder injuries (TABLE).7-13
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