A New Sling for Stress Incontinence
The TVT Secur sling is the first of the new Mini Slings and is a drastic change from other slings on the market and has modestly been described as a revolution by the company. It is only 8cm long and does not pass through the body and exit through the skin like other slings. This sling is self fixing to the soft tissues of the pelvis. There is minimal pain involved with the procedure and a much better safety profile than with previous slings as there is no need for the introducer to pass through the patient and exit the abdomen or groin..
Dr Farnsworth commenced using the TVT Secur in December 2006. To date he has completed 30 of the procedures with reasonable results. While efficacy seems less than in the traditional slings there are significant advantages with regard to safety and complications. A close audit of safety and efficacy is in progress and comparative trials are in the pipeline.
The diagram above shows the TVT Secur as it appears when removed from the packaging. Once it has been placed in position and the inserters have been removed only a small amount of mesh remains (Fig 2).
Figure 2: TVT Secur after removal of inserters
Potential Advantages of the TVT Secur
- Less invasive - there is a dramatic reduction in the amount of surgery. The sling penetrates only up to a maximum of 4cm on each side of the urethra. There is much less risk of trauma or bleeding.
- Less dissection - initial dissection is only 1-2 cm in total length
- Less anaesthesia - even local anaesthesia is possible
- Less pain - all of the patients that I have operated to date have reported no pain at all. There is no need for the sling to pass through the muscles of the abdomen or groin and there are no skin exits.
- Less complicated - the operative procedure is very simple and because of improvements in the tape itself there is less trouble actually adjusting the tape.
Durability
The TVT Secur has a special absorption fixation tip which provides a mechanical attachment prior to longterm integration of the mesh in the sling.
Figure 3: Tissue fixation tip provides mechanical fixation until tissue ingrowth is complete.
Long term durability and strength of tissue fixation is the key issue when it comes to widespread adoption of this technique. Concerns have been raised with regard to a higher rate of failure in some studies. There are no long term studies as yet because the technique is so new but animal studies have shown good tissue integration of the mesh by 12 weeks and excellent figures for tissue pullout (Figure 4).
Fig 4: Tissue fixation of TVT Secur
Frequently asked questions about TVT Secur
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