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Tension Free Transvaginal Tape (TVT Sling)
Surgical Technique Synopsis of TVT Sling
TVT Sling Figure 1
1 – Paraurethral dissection is performed after an initial midline incision on the anterior vaginal mucosa at the level of the midurethra. Note the small suprapubic abdominal incisions bilaterally.
TVT Sling Figure 2
2 – After bilateral dissection of the paraurethral space, the rigid catheter guide is inserted into the urinary catheter. The handle of the guide is deflected to the ipsilateral side and the needle is inserted into the paraurethral space.
TVT Sling Figure 3
3–The tip of the needle is angulated laterally and the endopelvic fascia is perforated just behind the inferior surface of the pubic symphysis.
TVT Sling Figure 4
4–After perforation of the endopelvic fascia, the tip of the needle is guided through the retropubic space along the backside of the pubic symphysis.
TVT Sling Figure 5
5–After perforation of the rectus fascia, a hand is used to palpate the needle tip suprapubically and guide the needle to the abdominal incision.
TVT Sling Figure 6
6–After the technique is repeated on the other side, the GYNECARE TVT sling is in place with the tape lying flat against the posterior surface of the midurethra.
TVT Sling Figure 7
7–The needles are detached and an instrument is placed between the tape and the urethra. Gentle traction on each end brings the tape in contact with the urethra and correct tension is adjusted with an intraoperative cough stress test.
TVT Sling Figure 8
8–The incisions are closed. The completed procedure allows fixation of the tape below the midurethra with the ends just below the skin level.
Antibiotics following TVT Sling Procedure
One gram of Ancerf is recommended pre-operatively. Additional peri-operative antibiotics should be administered clinically indicated.
Post-Operative Care
After the TVT Sling procedure, it is recommended that the patient refrain from heavy lifting and /or exercise (ie cycling, jogging) for at least four to six weeks. It is advised that sexual intercourse not be resumed for one month. The patient may return to routine activity one or two weeks after the tvt sling procedure. Should dysuria, bleeding or other problems occur, the patient should be instructed to contact the surgeon immediately. The patient should take ultimate care of herself after the TVT Sling surgery.