Moore 8/8/08 02:27 Page 105
New Minimally Invasive One-incision Sling for Treatment of Female Stress Urinary Incontinence
and patient subjective assessment of cure was 93.2% (55 of 59 patients trauma and bleeding. Fixation is excellent and immediate, and does not
considered cured of SUI symptoms). Subjective cure rate for SUI was alter with release of the placement needle. To test the fixation strength of
94.5% (Urinary Distress Impact [UDI]-6 score of 0 or 1). Urinary urgency the sling after it has been placed, we completed pull-out strength testing
and frequency symptoms were significantly present in 66% of patients on four unembalmed female cadavers after placing the MiniArc sling using
pre-operatively and in only 9.1% of patients post-operatively. Patient the standard technique described above. The average force required to pull
quality of life was also significantly improved after MiniArc sling out the sling was found to be 5.87lb (a calibrated force gauge that was
placement, with quality of life scores (Incontinence Impact Questionnaire
[IIQ]-7 and UDI-6) showing statistically significant improvement on both
assessment questionnaires.
Treatment for female stress urinary
Conclusion
incontinence has seen revolutionary
Treatment for female SUI has seen revolutionary changes during the last
10 years, with new minimally invasive techniques that have been proved
changes during the last 10 years, with
safe and effective. The TVT sling was developed first, and the TOT sling
new minimally invasive techniques that
followed, providing a safer means by which to place a TVT sling, with
seemingly equivalent cure rates and lower rates of voiding dysfunction.
have been proved safe and effective.
However, the TOT sling is not risk-free, as groin pain has been reported
in some series, especially with the inside-out approach. In attempts to
make the procedure even less invasive, with no needle passage required attached to a mosquito clamp was used to calculate pull-out strength). This
through the abdomen or groin, the single-incision mini-sling has been is approximately five times the force that an average pelvic floor event,
developed. This is the next logical step in the progression of minimally such as a cough, places on a sling.
19
Therefore, this should help hold the
invasive sling techniques. The TVT-Secur was the first mini-sling, released sling in place during the healing and tissue in-growth phase, which
in late 2006; however, initial results have not been as promising as ultimately may help in overall cure rates.
hoped. This may be secondary to the design of the kit, not the procedure
itself. The trocars are somewhat wide and cumbersome to place, and we The MiniArc sling can be implanted under local anesthesia with the cough
have found it difficult to release the trocar away from the mesh once test, or general anesthesia at the surgeon’s discretion. Early clinical results
placed in the sidewall. This can cause the sling to loosen and alter the in the current multicenter trial show it to be a safe and effective minimally
initial tensioning placed. Studies have reported a high learning curve, and invasive procedure for female SUI, with objective and subjective cure rates
surgeons are advised to place the sling tighter than one would with a at 12 weeks in the range of 93%. Further investigation with longer-term
TOT to try to prevent the possibility of loosening while attempting to follow-up and prospective studies are ongoing, and will add to the above
release the blade from the mesh. data; however, it does appear in initial studies that the mini-sling may
offer equivalent efficacy with a less invasive approach than the current
The newer MiniArc single-incision sling shows promising early clinical procedures being utilized today, and may be the next step in the minimally
results, and is the least invasive sling to be released to date. The procedure invasive treatment of female SUI. ■
has several advantages over currently available mini-slings on the market,
including being less cumbersome, with a smaller, less traumatic delivery Acknowledgments
system that is simple to use, and easy-to-control placement and We would like to thank Scott Serels, Ajay Rane, and Steve Wolfe for
adjustment/advancement of the sling into the pelvic sidewall, with minimal assistance in the MiniArc pull-out strength testing data.
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US OBSTETRICS & GYNECOLOGY 105
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