Anatomic relationships of the tension-free vaginal mesh trocars.
OBJECTIVE
The objective of the study was to describe the distances between the major anatomic structures to the path of the tension-free vaginal mesh (TVM) trocars.


METHODS
Four anterior transobturator and 2 posterior ischiorectal TVM trocars were inserted bilaterally into 8 fresh frozen cadavers. Dissections were performed and mean distances (95% confidence interval) were measured between the closest points along the trocar's path and significant anatomic structures.


RESULTS
The mean distances between both anterior transobturator trocars and the medial branch of the obturator vessels were 0.8 cm (range, 0.6 to 1.0) and 0.7 cm (range, 0.4 to 1.1), and bladder were 0.7 cm (range, 0.5 to 0.9) and 1.3 cm (range, 0.8 to 1.9), respectively. The mean distances between the posterior trocar and the rectum and inferior rectal vessels were 0.8 cm (range, 0.6 to 1.0) and 0.9 cm (range, 0.7 to 1.1), respectively.


CONCLUSIONS
The bladder and medial branch of the obturator vessel may be at risk of injury during the passage of the anterior trocars, whereas the rectum and inferior rectal vessels may be at risk during the passage of the posterior trocar.
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, Cleveland Clinic, Cleveland, OH, USA.
Chi Chiung Grace
CC
Chen
Arlan Marcus
AM
Gustilo-Ashby
John Eric
JE
Jelovsek
Marie Fidela R
MF
Paraiso
D000368:Aged; D002102:Cadaver; D004210:Dissection; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D012007:Rectum / Q000033:anatomy & histology* / Q000098:blood supply; D053825:Suburethral Slings; D013525:Surgical Instruments; D001743:Urinary Bladder / Q000033:anatomy & histology* / Q000098:blood supply; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000033:anatomy & histology / Q000601:surgery