This video demonstrate How to Perform Safe TVT, TOT and TVTO Lecture by Dr R K Mishra. Comparison of TVT, TVT-O/TOT and mini slings for the treatment of female stress urinary incontinence. Even though TO tapes and SIMS seem more efficient than TVT, they carry a risk of SUI re-occurrence that must be weighted towards the risk of potential complications after TVT. Trans Obturator (TO) group prevailed in efficiency with no significant differences between trans obturator route with inside-out (TVT-O) and outside-in (TOT). Success rate at 30th month evaluation, was higher in the TO group than in Tension-free Vaginal Tape (TVT) or Single-Incision Mini Slings (SIMS) group (93.4% vs 89.5%, 93.4% vs. 91.7%).
 

How to Perform Safe TVT, TOT and TVTO – Lecture by Dr. R. K. Mishra at World Laparoscopy Hospital

Stress urinary incontinence (SUI) is a common condition affecting many women worldwide, significantly impacting their quality of life. Modern minimally invasive surgical techniques such as Tension-Free Vaginal Tape (TVT), Trans-Obturator Tape (TOT), and TVT-Obturator (TVTO) have revolutionized the management of this condition. In an informative lecture at World Laparoscopy Hospital, renowned laparoscopic surgeon Dr. R. K. Mishra explained the principles, techniques, and safety measures required to perform these procedures effectively.

Dr. Mishra emphasized that the success of TVT, TOT, and TVTO procedures lies in proper patient selection, a thorough understanding of pelvic anatomy, and meticulous surgical technique. These procedures are designed to provide support to the mid-urethra using a synthetic mesh tape, which helps restore normal urinary control during activities such as coughing, sneezing, or physical exertion.

During the lecture, Dr. Mishra explained that the TVT procedure involves placing a polypropylene mesh tape under the mid-urethra through a small vaginal incision. The tape is passed through the retropubic space and exits near the lower abdomen. This method creates a supportive hammock under the urethra, preventing leakage while maintaining normal urination. However, because the retropubic space contains vital structures such as the bladder and blood vessels, surgeons must take special care to avoid injury.

To overcome some of the risks associated with the retropubic approach, the TOT (Trans-Obturator Tape) technique was developed. In this procedure, the tape passes through the obturator foramen rather than the retropubic space. Dr. Mishra highlighted that the TOT approach reduces the chances of bladder and bowel injury while maintaining high success rates. The surgeon makes small incisions in the groin area and guides the tape through the obturator pathway to support the urethra safely.

Another variation discussed in the lecture was the TVTO (TVT-Obturator) technique, which combines the advantages of both TVT and TOT approaches. This method also uses the obturator route but follows a specific pathway that improves safety and precision. Dr. Mishra demonstrated how careful positioning of instruments and correct tape tension are essential to ensure effective results without causing urinary obstruction.

A major focus of the lecture was safety during surgery. Dr. Mishra stressed the importance of cystoscopy after tape placement in the TVT procedure to confirm that the bladder has not been injured. Gentle tissue handling, maintaining proper anatomical landmarks, and avoiding excessive tape tension were highlighted as critical steps to minimize complications. He also advised surgeons to be well trained and experienced before performing these procedures independently.

In addition to the surgical steps, Dr. Mishra discussed postoperative care and patient follow-up. Most patients undergoing TVT, TOT, or TVTO procedures experience minimal pain, short hospital stays, and rapid recovery. However, proper monitoring is essential to detect rare complications such as urinary retention, infection, or mesh-related issues.

The lecture at World Laparoscopy Hospital provided valuable insights for surgeons seeking to improve their skills in urogynecological procedures. Through clear explanations, surgical demonstrations, and practical tips, Dr. R. K. Mishra highlighted the importance of combining advanced surgical knowledge with strict safety protocols.

In conclusion, TVT, TOT, and TVTO procedures represent highly effective minimally invasive solutions for stress urinary incontinence. When performed with proper technique and adherence to safety guidelines, these procedures offer excellent outcomes and significantly improve patients’ quality of life. The lecture by Dr. Mishra continues to guide surgeons worldwide in performing these procedures safely and successfully.