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The ends of the graft sling suture (often referred to as arms or tails) are passed upward through the retropubic space using the eyelets of the Stamey needle or the clamp.
Furthermore, as our standard technique to midurethral sling removal involves a combined vaginal and laparoscopic approach with dissection of the retropubic space, the inclusion of a laparoscopic Burch urethropexy at time of surgery would not entail any further dissection given that the space was already open [14, 16, 17].
After the sling "pops" into the retropubic space, I remove my hand from the vagina and place it on the abdominal wall at the ipsilateral suprapubic poke site.
Thread the free ends of the sutures affixed to the sling into the ends of the Stamey needles--or grasp them with clamps--and pull each suture up to the anterior abdominal wall through the retropubic space (FIGURE 5).
The transobturator approach was developed to minimize the potential for bladder and bowel injuries by avoiding the pelvic organs in the retropubic space.
Some place smaller, 3-mm trocars in a similar "bottom-up" fashion, as the TVT sling does; others utilize smaller trocars that are placed "top down" through the retropubic space into the vagina.
Measurements taken following bilateral insertion of the TVT needles into 10 female cadavers revealed that the major vessels in the retropubic space and anterior abdominal wall lie just 0.
No evidence of metastatic disease was noted; however, a grossly thickened irregular mass was seen, involving the anterior bladder wall and retropubic space, consistent with a muscle invasive bladder cancer (Fig.
We're not inserting any needles through the retropubic space, so you don't have to worry about puncturing the bladder or bowel or causing vascular injury," he said at the meeting, which was jointly sponsored by the Society of Pelvic Reconstructive Surgeons and the American College of Obstetricians and Gynecologists.