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Operative Technique
Continuing in
Transobturator Approach of Sling Placement
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This segment will explain the preparation in operation theatre before starting the procedure.
Keywords
- Anesthesia
- Patient positioning
- part preparation
- confirmation of landmarks
- catheterization
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Amita Jain
- First online
- 23 September 2020
- DOI
- https://doi.org/10.1007/978-981-15-8895-2_3
- Online ISBN
- 978-981-15-8895-2
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020
Video Transcript
Preoperative preparation. The transobturator sling procedure can be performed with the patient under local anesthesia, with intravenous sedation, spinal anesthesia, or general anesthesia. Because the surgery is focused on the vagina and perineum only, patients are positioned in the high dorsal lithotomy position, with the legs in hyperflexion. That is, at around 120 degrees. And a full vaginal and perineal preparation is performed.
A number of visible and palpable landmarks must be recognized for proper placement of the tape. With the woman’s thigh in hyperflexion, the adductor longus tendon can be pinched between the thumb and index finger. Superior medial angles of left and right obturator foramina are marked just below the tendon of adductor longus at the level of clitoris lateral to the inguinal gluteal fold. That is the crease between the labia majora and the thigh.
In all of these patients, this angle of obturator foramen itself can be palpated as a notch along the internal edge of inferior pubic ramus and below the adductor longus tendon by putting index finger inside and thumb outside. And outside incision sites can be marked. Catheterization is done to drain bladder. After inflating the catheter balloon, the position of bladder neck can be appreciated on giving traction on the catheter and palpating the inflated balloon. This makes easy to decide the location of midurethra, which should be the site of vaginal incision and subsequent sling placement.