ADVANTAGE SLING PROCEDURE
| After preparaion of the lower abdominal and vaginal operative sites, create two small transverse abdominal incisions approximately 0.5 to 1cm on each side of the midline just above the symphysis. Incise the anterior vaginal wall and dissect bilaterally in standard fashion. |
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| Resting the tip of the needle on the palmar surface of the non-dominant index finger, gently introduce the Deliver Device anterolaterally into the paraurthral space and perforate the endopelvic fascia. Carefully pass the Deliver Device through the space of Retzius and perforate the rectus sheath and muscle. Guide the divice by palpation into the ipsilateral abdominal incision until the needle tip is exposed trough the incision. | |
| When the needle tip/dilator tube assembly extends extr-abdominally, advance the tube starter on the handle forward which will cause the dilator tube to advance beyond the tip of the needle. Grasp the dilator by placing a clamp or hemostat on the free end of the dilator end to temporarily secure it extra-abdominally. Remove the needle from inside the dilator by pulling it out of thedilator and out of the vagina. The dilator tube/mesh assembly should remin in place. Repeat on the contra lateral side. At this point, the two dilator tubes will be in place and cystoscopy should be performed to confirm bladder integrity. | |
| Tension the mesh by pulling upwards on both dilators simultaneously so that urine leakage is limited to no more than one or two drops. When the appropriate tension is attained, grasp the blue centering tab and cut the tab trough the center of the punch hole. Make sure to remove both halves of the blue tab. | |
| Remove the protective sleeve by pulling upwards on both dilators simultaneously and verify the tension of the mesh and adjust mesh tension, if necessary. | |
| Once the desired tension has been achieved, gently push downward on the abdomen, cut the distal ends of the mesh and allow those ends to retract into the incision. Close the incisions in the usual manner. |