Additional video images can be found in the online version of this article. Visit http://onlinelibrary.wiley.com/
Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author.
[ Concept of the tension-free vaginal mesh (TVM) procedure. Before we describe the surgical techniques, let us confirm the concept of the TVM procedure. TVM uses a mesh to support and reinforce both the vaginal wall and vaginal canal. The mesh reinforces the anterior and posterior vaginal wall. In anterior TVM (TVM-A), four arms are passed through the obturator foramen to the arcus tendineus fascia pelvis (ATFP) to restore lateral support. In posterior TVM (TVM-P), two arms are passed to the sacrospinous ligament to reinforce the sacrouterine ligament. ]
[ Correct separation of layers. This photograph shows the full-thickness incision of the vaginal wall following sufficient fluid separation. The vaginal wall adheres to the vaginal mucosa, and in conventional vaginoplasty the mucosal layer was separated from the muscle layer. In the tension-free vaginal mesh procedure, the adventitia layer between the full thickness of the vaginal wall and the bladder is separated. ]
[ Properly securing the mesh to the vaginal wall and cervical canal (posterior TVM [TVM-P]). Properly securing the mesh is important for preventing recurrence and sufficient expansion of the mesh. In TVM-P, it is effective to (a) securely fix three points on the cervical canal with a non-absorbable suture, and (b) fix three points on the vaginal wall on the perineal side with an absorbable suture. ]
[ Properly securing the mesh to the vaginal wall and cervical canal (anterior TVM [TVM-A]). In TVM-A, it is effective to (a) fix three points on the vaginal wall on the side of the bladder neck with an absorbable suture and (b) three points on the cervical canal with a non-absorbable suture. ]