How to Apply Transobturator and Transvaginal Tape Needles: A Cadaveric Demonstration Study with Anatomical Landmarks

Abstract

Objective: This study aimed to demonstrate a proper method of performing transobturator tape (TOT) and transvaginal tape (TVT) needle (trocar) insertion with anatomical landmarks on a cadaver. Material and Methods: In April 2017, at Prof. Rhoton Anatomy Laboratory, Bahcesehir University, Istanbul/Turkey, the cadaveric workshop of Pelvic Reconstructive and Functional Urology Surgery, an advanced masterclass on anatomy and surgery using fresh frozen cadavers was held. During the course, transobturator tape (TOT, outside-in method) and transvaginal tape (TVT, bottom-to-top method) procedures were performed on a cadaveric model with a detailed dissection of anatomical landmarks. Results: After passing the skin, TOT needle passes just beneath the adductor longus tendon and through the gracilis tendon, adductor brevis tendon, obturator externus muscle, obturator membrane, obturator internus muscle, and endopelvic fascia, so comes out from the vaginal incision. During this course, there was a risk of injury to the obturator nerve. The average distance of TOT needle to the obturator nerve was found 1.9cm. However, for the TVT operation, the risk of vascular, bowel, or bladder injury was higher than the TOT operation because of the retropubic pathway. The average distance of TVT needle to the obturator neurovascular bundle at the retropubic space was found 3.4 cm. Conclusion: Performing the TOT and TVT needle insertions properly with correct hand movements and anatomical knowledge of neighbouring structures will decrease the risk of complications.