Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator Suburethral Sling
Open Access
- 15 July 2021
- journal article
- Published by VSMU N.N. Burdenko in Journal of Anatomy and Histopathology
- Vol. 10 (2), 23-29
- https://doi.org/10.18499/2225-7357-2021-10-2-23-29
Abstract
The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling. Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence. Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe. Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.Keywords
This publication has 18 references indexed in Scilit:
- Relationship between the shape of the obturator foramen and the shape of the pelvic cavity in adult womenAnatomy, 2020
- Mid-urethral sling operations for stress urinary incontinence in womenEmergencias, 2017
- Pelvic organ prolapse: the impact on quality of life and psychological well-beingJournal of Psychosomatic Obstetrics & Gynecology, 2017
- Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysisInternational Urogynecology Journal, 2017
- Persistent pelvic pain following transvaginal mesh surgery: a cause for mesh removalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2012
- Anatomical variation of bony pelvis from the viewpoint of transobturator sling placement for stress urinary incontinenceInternational Urogynecology Journal, 2011
- Anatomic Variations of the Obturator Nerve in the Inguinal RegionRegional Anesthesia & Pain Medicine, 2009
- Minimally invasive treatment for female stress urinary incontinenceExpert Review of Obstetrics & Gynecology, 2008
- Novel Surgical Technique for the Treatment of Female Stress Urinary Incontinence: Transobturator Vaginal Tape Inside-OutEuropean Urology, 2003
- Architectural Differences in the Bony Pelvis of Women With and Without Pelvic Floor DisordersObstetrics & Gynecology, 2003