TREATMENT OF FEMALE STRESS URINARY INCONTINENCE (SUI) Entrer la date

Mini Invasive Vaginal Tape MIVT

MIVT PRESENTATION Polypropylene monofilament tape Macropores > to 75 microns => Meets the AFNOR requirements Sizes: 11 x 1.2 cm. Both ends are fitted with 1 gusset for a good anchorage into the tissue Provided with 1 insertion tool in case of difficulties to find the dissection tunnel

MIVT PRESENTATION

MIVT PRESENTATION

MIVT PRESENTATION A mini invasive vaginal tape has to meet to 2 main important characteristics: EASY AND REPRODUCIBLE MANOEUVRE ANCHORAGE ADJUSTMENT

MIVT PRESENTATION Anchorage: the double gussets assure a good positioning of the tape. One side: tension strength: 19.75 N Two sides: tension strength: 25.5 N Adjustment: As the tape is exclusively composed of monofilament polypropylene, the surgeon can push or release the tape as many times as he wants. (tissues are usually shred but not with a polypropylene tape => MiniArc tissues are shred)

MIVT PRESENTATION Selling point: Easy and reproducible manoeuvre Efficiency: Similar to the TVT/TOT

MIVT PRESENTATION • No need to cross the obturator membrane: Reduction of the immediate post-operative pains (3 to 10% of all cases). => Reduction of the post-operative neuralgic risks: even if it is very rare, it is one of the most dangerous accident that can occur after a TOT intervention.

ANATOMIC DISSECTION Pubic bone MIVT exit TOT entrance Neuro-vascular bundle Posterior branch of obturator nerve Bladder

PRESENTATION OF MIVT IMPLANTATION • Anaesthesia: - local, regional or general.

PRESENTATION OF MIVT IMPLANTATION Installation of the patient: Gynaecological position

PRESENTATION OF MIVT IMPLANTATION Material:

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: The draining of the bladder must be performed before the incision, as for the TVT or TOT methods. A 2 cm deep median incision is made on the anterior vaginal wall, 1.5 cm under the urinary meatus. A dissection from both part of the urethra is made with Metzenbaum scissors until the ischio-pubic ramus and behind to open the pelvic aponeurosis or urogenital membrane (a dip must be felt by the surgeon).

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: The point of the Jones scissors is slipped into the gusset of the tape. Using the scissors, locate the middle of the tape (screw or opening line of the scissors). Take the dissection tunnel with the scissors + the tape, go behind the ischio-pubic ramus, through the urogenital membrane or pelvic aponeurosis, then push the tape until the mark on the scissors. The same manoeuvres are performed on each side.

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: The middle of the tape must be marked. Middle

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: Other possibility: If the surgeon experienced some difficulties to find the tunnel, the guide (slide) may be used to find the dissection tunnel.

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

PRESENTATION OF MIVT IMPLANTATION Operating technique: Adjustment: the MIVT tape is inserted against the urethra without tension.

PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

PRESENTATION OF MIVT IMPLANTATION • Extraction of the tape (from a suprapubic incision view)

PRESENTATION OF MIVT IMPLANTATION • Extraction of the tape (from a suprapubic incision view)