Tip/Trick 3

Abstract

OBJECTIVE: The objective of this tip and trick is to demonstrate our method of improvising a mid urethral sling utilizing the handle piece from an obturator midurethral sling kit and cut polypropylene mesh in order to make the procedure economically possible and time efficient while performing this operation in the austere conditions of a Third World country. DESCRIPTION: Improvisation of the device begins with the handle piece from a kit with the piercing sheaths removed. These are sterilized in Cidex OPA solution. A single 18x12 inch sheet of polypropylene mesh is cut into 1.5 cm wide by 30 cm length strips. A #0 vicryl suture is secured to the distal ends of the cut mesh and tightly secured around the groove at the distal end of the handle piece. The procedure is then performed in the usual manner of placing a midurethral obturator sling with the following exceptions: A small stab incision is made at the location of the exit point of the device in the inner upper part of the thigh creases bilaterally. Using a tonsil clamp, the stab incision is opened in the direction of the obturator foramen. The vaginal incision and dissection toward the obturator foramen bilaterally are performed in the usual manner. The device is then passed through the obturator membrane and toward the previously created stab incision. Once through the stab incision, the #0 vicryl suture is grasped with a Kelly clamp and cut free from the device. The device is then reversed out and the mesh is gently pulled through the stab incision. The tape is then tensioned and incisions are closed in the usual manner. Average time of procedure including fashioning the device, 24 minutes. Average cost per sling, $19 USD. CONCLUSION: As utilized during a recent mission to Honduras with a limited budget, the improvised midurethral sling proved to be an economical, time efficient method of placing the midurethral sling in an austere environment.