Posterior transgluteal approach

An incision is made in the vaginal wall, centrally through the entire thickness of the vagina including the vaginal epithelium and underlying fascia. Using scissors, a space is created perpendicular to the mid-section of the incision, progressing sideways in the pararectal space along the elevator muscles, until the ischial spine is visible. The dissection is then repeated on the opposite side.
The needle insertion point is 3 cm to the side and 3 cm below the anal border, performing two 5 mm skin incisions. The Herniamesh transgluteal needle is inserted into one of the skin incisions through the ischiorectal fossa, keeping the handle grip parallel to the horizontal plane.
With one finger in the vagina, the tip of the needle is guided through the pararectal fossa, located between the ischial and sacral spines, below the sacrospinous ligament. The tip of the needle is passed through the ileococcygeal muscle via the ischiorectal fossa and pararectal fossa. In this way the needle is made to exit via the vaginal incision performed previously, the sutures pre-assembled on the T-Sling PP or on Pelvimesh posterior prosthesis are inserted into the needle and the mesh is positioned by withdrawing the needle.

The same procedure is then followed on the opposite side. A rectal exploration must then be performed to ensure there is no perforation of the rectum. The prosthesis is sutured by means of some stitches, placing the sling under tension, after which the excess sling is cut away at skin level. The skin and finally the vaginal incision are then sutured.

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