PMC5107866_01
Tagged vaginal arms of transected TVT sling. The minisling has been dissected away from the suburethral tissue and isolated with a right-angle clamp prior to cutting in the midline. Permission to reprint from Miklos and Moore.
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They were tagged for later identification and laparoscopic extraction (Figure 1). Burch urethropexy was then performed laparoscopically using CV-2 nonabsorbable polytetrafluoroethylene (Gore-Tex ) figure-of-eight sutures, placed bilaterally 1 cm lateral to the midurethra and at the level of the urethrovesical junction.
Identification of the arms of the RP sling entering through the pubocervical fascia and extending up to the abdominal wall within the retropubic space. Permission to reprint from Miklos and Moore.
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The arms of the RP sling entering through the pubocervical fascia were identified and were followed to the anterior abdominal wall on each side of the pubic symphysis (Figure 2).
Arms of the mesh sling dissected away from the abdominal wall near the pubic rami prior to vaginal removal. Permission to reprint from Miklos and Moore.
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The dissection was continued and the arms of the mesh sling were dissected away from the posterior aspect of the pubic ramus, down through the pubocervical fascia and, once free, the arms were both removed vaginally (Figure 3).
Laparoscopic Burch urethropexy with a paravaginal repair following sling removal. Permission to reprint from Miklos and Moore.
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They were tied to create appropriate bridging and tension without kinking the urethra (Figures 4 and 5).
Illustration of Burch urethropexy and paravaginal repair. Permission to reprint from Miklos and Moore.
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They were tied to create appropriate bridging and tension without kinking the urethra (Figures 4 and 5).