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TVT Secur Surgical Technique and Learning Tips and Tricks |
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| TVT Secur Surgical Technique and Learning Tips and Tricks |
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| 作者：Lucente … 文章来源：IUGA2008 点击数： 更新时间：2008-10-2 0:54:50 |
TVT Secur Surgical Technique and Learning Tips and Tricks
Lucente V, van Raalte H, Molden S
Institute for Female Pelvic Medicine, United States
Industry Support: No (Investigator initiated, no external funding)
Objective:
The purpose of this video is to demonstrate our learned techniques and tips in placement of the new TVTSecur
mini-sling for the treatment of stress urinary incontinence (SUI).
Background:
Surgical treatment of stress urinary incontinence has evolved over the past 10 years, now involving
standard placement of mesh tapes at the level of the midurethra. Continuing the trend toward less invasive
surgical techniques, new “minisling” procedures are the most recent treatment option now available.
These slings theoretically offer decreased patient morbidity and discomfort and hold the potential for use as
an office procedure.
Methods:
The video was created by editing 3 separate operative procedures together to highlight the key procedural
steps and emphasize important tips and tricks learned over time to achieve maximum dryness rates.
Positioning, anesthesia and the two different types of sling placement are also described. Informed consent
was obtained from each patient and IRB approval was granted.
Results:
During our initial use of TVT Secur we recognized a learning curve with apparent improvement in dryness
rates after modifying our original surgical technique. The video highlights the key learning points we have
experienced. These include techniques such as: minimal hydrodissection, limited periurethral dissection to
the pubic rami, proper hand placement during tape delivery, and attention to insertion direction throughout
device delivery. Significant improvement in dryness rates were also realized after use of a malleable
retractor was implemented for insertion device removal. This allowed for minimal disruption of the mesh
tape during the removal. Cough testing was used for initial sling adjustment. Repeat cough testing was
then used after removal of the first inserter for final adjustment prior to removal of the second insertion
device. We have found that placement of the TVT Secure must be tighter against periurethral tissues to
ensure optimal dryness as compared to its predecessors. In a retrospective chart review of 77 patients with
six week follow-up was also performed. All patients had the procedure performed under local/regional
with sedation. . The average age was 60 years (±13.1) with a BMI of 29 (±5.6) and parity of 3 (±1.3). 37
patients (50.6%) underwent concomitant prolapse surgery at the time of sling placement. The mean OR
time was 26.3 (± 8.6) minutes and mean EBL was 45.4 (± 40.6) ml. In total, 27 patients (35.1%) received
the “U” placement while 50 (65.9%) received the “hammock” configuration. Of these, 53 (68.8%)
displayed no post-op SUI, 2 patients (2.6%) experienced voiding dysfunction with 1 patient undergoing
sling revision, and only 1 patient (1.3%) complained of pain at six weeks. Of the 24 (31.2%) patients with
persistent SUI, 40% were improved compared to pre-op and did not desire further treatment. Compared to
the overall cure rate, the last 25 patients demonstrated a higher cure rate of 80%.
Conclusions:
Preliminary results of the TVT-Secur procedure suggest it to be as efficacious as its predecessors, the
midurethral retropubic and transobturator pubovaginal slings, for the surgical treatment of SUI. There
appears to be a slight but clinically insignificant increase in blood loss. There is a real learning curve as
demonstrated by the improvement in outcomes seen over time. The new TVT-Secur has displayed a
significant decrease in post-operative discomfort and suggests a decrease in voiding dysfunction. |
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