The relationship of tension-free vaginal tape insertion and the vascular anatomy.
OBJECTIVE
To describe the proximity of the major vessels in the retropubic space and anterior abdominal wall to the tension-free vaginal tape needle.


METHODS
Tension-free vaginal tape needles were inserted bilaterally in ten cadavers. Dissection of the superficial epigastric, inferior epigastric, external iliac, and obturator vessels was performed. Measurements from the lateral aspect of the needle to the medial edge of the vessels were recorded. In an additional cadaver, three planes were created by placing a string from the midlabia to the shoulder, mid-biceps brachii muscle, and 6 cm lateral to the mid-biceps brachii muscle of the cadaver's extended, ipsilateral arm. An operator, blinded to the retropubic space anatomy, passed the needle in these planes bilaterally. The distances from the needle to the external iliac and obturator vessels were measured.


RESULTS
All vessels measured were lateral to the tension-free vaginal tape needle. The mean distance from the tension-free vaginal tape needle to the obturator vessels was the closest: 3.2 cm (range 1.6-4.3 cm). The mean distance from the tension-free vaginal tape needle to the superficial epigastric vessels was 3.9 cm (range 0.9-6.7); to the inferior epigastric vessels, 3.9 cm (range 1.9-6.6 cm); and to the external iliac vessels, 4.9 cm (range 2.9-6.2 cm). When the needle was directed 6 cm lateral to the mid-biceps brachii muscle, the external iliac vein was punctured.


CONCLUSIONS
The major vessels in the retropubic space and anterior abdominal wall lie 0.9-6.7 cm lateral to the tension-free vaginal tape needles. If the tension-free vaginal tape needle is laterally aimed or rotated, major vascular injury can occur.
Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Tristi W
TW
Muir
Paul K
PK
Tulikangas
Marie
M
Fidela Paraiso
Mark D
MD
Walters
D034861:Abdominal Wall / Q000098:blood supply*; D002102:Cadaver; D005260:Female; D006801:Humans; D009339:Needles; D014550:Urinary Incontinence, Stress / Q000601:surgery; D013520:Urologic Surgical Procedures; D014621:Vagina / Q000098:blood supply*