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Master Class in Gynecologic Surgery: Transobturator Mid-Urethral Sling Placement

The Ob. Gyn News’ Master Class in Gynecologic Surgery is hosted by AAGL SurgeryU, and is edited by Dr. Charles E. Miller, a past president of the AAGL, and a long standing faculty member of SurgeryU. This month’s edition of the Master Class covers strategies for transobturator mid-urethral sling placement.


Transobturator Mid-Urethral Sling Placement

Courtesy of Eric R. Sokol, MD
Associate Professor of Obstetrics and Gynecology
Associate Professor of Urology, by Courtesy
Co-Chief, Urogynecology and Pelvic Reconstructive Surgery
Stanford University School of Medicine

Mid-urethral slings–including transobturator slings–have become standard therapies for the treatment of stress urinary incontinence. In this procedure, mid-urethral vaginal tunnels are created after hydrodissection, allowing a finger to be placed behind the obturator internus muscle. Poke incisions are made beneath the adductor longus tendon and lateral to the descending ischiopubic ramus. With a finger protecting the urethra, the trocar is pushed at a 35-degree angle through the adductor muscles and obturator membrane while hugging the bone, until the tip is felt by the index finger. The trocar is rotated out through the incision, and the sling is attached and then pulled back through the tunnel. A Metzenbaum scissor is used as a spacer to prevent over-tensioning. 

Filed under "Master Course in Gynecologic Surgery".

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