Newer transobturator sling technique said to be safer.(Gynecology)

ST. LOUIS -- Placing a transobturator sling with a newer technique that starts inside the paraurethral space and progresses outward is both safer and more effective than the "outside-to-in" approach, according to Robert M. Rogers Jr., M.D., an expert in vaginal surgery.

Transobturator (TOT) slings are most commonly threaded through a skin incision in the pelvis and pulled through to the paravaginal space (the outside-to-in approach). This traditional approach poses the risk of bladder and urethra perforation and laceration of the anterior branch of the obturator artery, he explained at the 14th International Pelvic Reconstructive and Vaginal Surgery Conference.

In contrast, the "inside-to-out" approach begins laterally, away from the bladder and urethra, and twists helical-shaped passers away from the danger zones, said Dr. Rogers of Reading Hospital and Medical Center in West Reading, Pa.

"When you put the helical passers through and you drop the handle vertically into the perineum as you rotate, the engineering of the device keeps you out of trouble," Dr. Rogers, a consultant and speaker for Gynecare, which makes the passers, said in an interview.

The outside-to-in approach involves a directional force toward the bladder and urethra. To protect these structures, the surgeon must dissect the adjacent paraurethral and paravaginal areas to place a finger to meet the instrument as it passes through the ...