Transobturator Vaginal Tape in 10 Steps.

Objective: Transvaginal tension-free vaginal tape-obturator (TVT-O) is an effective surgical treatment for stress urinary incontinence in women [1]. A correct preoperative urodynamic study has a role in obtaining the best results. However, some complications still occur during and after this surgical procedure. These complications cause a high burden for patients, who frequently have to receive other invasive treatments subsequently. The main objective of this video is the standardization and accurate description of this surgical procedure while adding some tips and tricks.

Design: Step-by-step description of the technique through a video.

Setting: A French tertiary care teaching hospital.

Interventions: `The local institutional review board was consulted and ruled that approval was not required. Patients cannot be identified and they signed a written consent to use video-recording for research, scientific and teaching purposes. We provided this video of TVT-O procedures to identify more delicate steps of this surgical procedure to clarify managing them successfully. We assessed 10 rational steps in the procedure to standardize it. This video presents clearly the standardization of this technique in 10 steps: (1) patient's ergonomy, (2) anesthetic infiltration, (3) single vaginal incision, (4) creation of the pathway for device placement, (5) placement of the device, (6) check flat position of the tape, (7) obtain the correct tension of the mesh, (8) cut both lateral arms of the tape emerging from the skin, (9) urinary drainage to exclude stenosis, and (10) suture vaginal mucosa and skin.

Conclusion: Together with an appropriate preoperative study, the standardization of this surgical procedure and the application of tips and tricks suggested could make this technique easier to learn for beginners [2] and could help experienced surgeons in reducing, as much as possible, the most frequent complications as well [3].