Anaesthesia: general, spinal or local.
Preoperative single-dose antibiotic prophylaxis and postoperative antibiotic therapy.

An accurate internal and external genital disinfection is performed with the patient in the lithotomic position. The bladder is emptied by placing a urinary catheter.

Delimitation of the incision area on the anterior vaginal wall with two non-traumatic forceps situated at 1 cm and 3 cm from the urethral meatus proximally.

After an injection of physiological solution into the sub-urethral and paraurethral tissues, an anterior longitudinal colpotomy, 1 cm long, is performed just beneath the urethral mucosa.

Sub-mucosal tissue detachment and arrangement of access of the device. Using a curved Metzenbaum scissor, the surgeon creates two tunnels, one for each paraurethral side, 3.5 cm long, towards the obturator foramen and keeping the same direction followed by the TOT technique. The obturator membrane can be touched lightly but not penetrated.

The two arrow-shaped ends of the T-Sling® Plus are approached each other to form a plane perpendicular to the plane of the sling itself and block them with the Halsted Mosquito forcep micro, with anatomic curved tip. The forcep is passed through the tunnel just set up into the periurethral tissues and realesed: the flexible arrow-shaped end opens and lays, taking its original shape, anchoring itself in the tissues.
Repeat the same steps on the contralateral side.

Once the device is anchored in the periurethral space, perform the colporraphy of the vaginal incision, both right and left side of the urethra, with generous well separated introflecting stitches, paying attention that there is a wide distance between the stitch and the margin of incision.

The suture is performed paying attention to taking at least almost 1 cm of vaginal mucosa per side.

3 medicated and wet gauzes are pushed into the vagina, sideways and beneath the urethra. They are removed, together with the urethral catheter, 8 to 24 hours after surgery.
Operative time: less than 10 minutes.

Advantages of the T-Sling® Plus:

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