TVT PROCEDURE            –           TOT PROCEDURE
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TVT PROCEDURE – TOT PROCEDURE PowerPoint PPT Presentation


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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.

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TVT PROCEDURE – TOT PROCEDURE

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Tvt procedure tot procedure

  • TVT PROCEDURE – TOT PROCEDURE


Tvt procedure tot procedure

  • TOT helicoidal needle

  • TOT semi-circular needle

TVT needle


Tvt procedure tot procedure

  • TOT POSITION OF THE MESH

    Themeshis placed underthemid-urethra and thetips of themesh come outfromthebodythroughtheObturator foramen.


Tvt procedure tot procedure

  • TOT POSITION OF THE MESH


Tvt procedure tot procedure

  • TYPES OF APPROACHES:

    TOT – TransObturatorTape( INOUTtechnique)

    TOT – TransObturatorTape ( OUTINtechnique)


Tvt procedure tot procedure

Step 1

  • out-in TOT PROCEDURE (mostcommon)

  • 2 cm anterior vaginal wall incision

  • Periurethral scissor dissection.


Tvt procedure tot procedure

Step 2

  • out-in TOT PROCEDURE

  • Area of groin incision located

    1 cm inferior to the Adductor

    LongusTendinous insertion,

    at the level of clitoris.


Tvt procedure tot procedure

Step 3

  • 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.


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Step 4

  • out-in TOT PROCEDURE

  • The needle passed through the groin incision, through the Obturator membrane and muscles and brought into the vaginal incision.


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Step 5

  • 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.


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Step 6

  • out-in TOT PROCEDURE

  • The needle with the attached thread of the mesh is then brought back through the groin incision.


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Step 7

  • 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.


Tvt procedure tot procedure

Step 8

  • out-in TOT PROCEDURE

  • Excess mesh is cut off at

    the groin incisions and

    these are closed with

    steri-strips.

  • Vaginal incision is closed.


Tvt procedure tot procedure

  • 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 tot procedure

  • 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.


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