Transobturator vaginal tape inside-out. A minimally invasive treatment of stress urinary incontinence: surgical procedure and anatomical conditions.
OBJECTIVE
The aim of this study was to review the surgical transobturator vaginal tape inside-out (Gynecare TVT-O, Ethicon Inc., Somerville, NJ) technique as described by de Leval and to present the relevant anatomical conditions of the lower pelvis on the basis of corpse dissections after TVT-O placement.


METHODS
In order to visualize the anatomical structures through which the tape runs, anatomical dissections of five corpses after TVT-O placement were performed. Furthermore, the dissections made possible to give a detailed description of the neighbouring neurovascular structures.


RESULTS
The anatomical dissections show that the transobturator tape does not reach into the retropubic space at any time during the procedure, so that injuries of the bladder, of the epigastric vein and the external iliac vessels are not to be expected. The distance between the tape and the major neighbouring neurovascular structures shows slight individual differences, however without the danger of neurovascular injuries if the surgical procedure is performed as recommended.


CONCLUSIONS
Precise knowledge about the anatomy of the area of operation provides the surgeon with the possibility to safely conduct the operation and it contributes to a reduction of perioperative complications.
Reisenauer
Christl
C
Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany. christl.reisenauer@med.uni-tuebingen.de
Kirschniak
Andreas
A
Drews
Ulrich
U
Wallwiener
Diethelm
D
D002102:Cadaver; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation; D019919:Prosthesis Implantation / Q000295:instrumentation*; D053825:Suburethral Slings; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina