(*) Dept of Obstetrics and Gynaecology, Hall, Austria,
(**) Royal Perth Hospital, University of Western Australia,
(***) Gallier’s Hospital, Armadale, Western Australia
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Figure 1. – TFS anchor. The polypropylene tape is applied under direct vision, using the anchor to fix it adjacent to the damaged ligament or fascia: pubourethral (PUL), arcus tendineus fascia pelvis (ATFP), cardinal ligament (CL), uterosacral (USL). A one-way tightening mechanism at the base of the anchor tensions the tape to restore optimal length, and therefore function, of the damaged structure. |
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Fig. 2. – The Pictorial Diagnostic Algorithm was used to determine
where the TFS tapes were to be applied. The algorithm summarizes
the relationships between connective tissue damage in the three
zones and symptoms. The size of the bar gives an approximate indication
of the prevalence (probability) of the symptom. Connective
tissue structures in each zone may cause prolapse and abnormal
symptoms. |
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Fig. 3. – Anterior TFS sling. 3D sagittal view. A polypropylene
mesh tape sited at midurethra and attached in the pelvic muscles
below pubic symphysis (PS) reinforces the pubourethral ligament. |
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Fig. 4. – Posterior TFS sling. The tape is inserted along the line
of the uterosacral ligaments “USL” between USL and vagina “V”.
CL=cardinal ligament. The suture approximates the fascia overlying
the tapes. |
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Fig. 3. – TFS “U sling” - View into the anterior vaginal wall. Vagina
(V) is dissected off the bladder wall, and stretched laterally. The
TFS tape is anchored (A) just medial to the obturator fossa (OF)
muscles. Sutures (S) may be used to attach the tape to the vaginal
fascia.. |
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Fig. 6. – Transverse TFS Sling The bladder was dissected from
the vaginal wall as laterally as possible. After repair of the fascial
fragments, the anchor was attached to the ATFP (Arcus tendineus
Fascia Pelvis) or adjoining muscle and tightened. The inferior tape
reinforces the cardinal ligament. |
