abiss CYRENE Instrucciones De Uso página 13

● third stage, passage of the instrumentation across the perineal membrane guided by the fi nger until
outside the vaginal incision. Passage across the perineal membrane is performed laterally to the ure-
thra at the level of the middle third.
- Check visually that the tunneller has not pierced the vagina.
- Introduce about 3 cm of the tapered end of the sling into the eye of the tunneller.
- Put the sling into position by reversing the tunneller. The sling must be located between the urethra
and the fascia, and not between the fascia and the vaginal mucosa (risk of extrusion, erosion and
necrosis).
- Ensure that the sling is not twisted under the urethra.
- It is important to leave a visible space (3 – 5 mm) between the urethra and the sling, so that the sling
can be adjusted tension free.
- Closure in a single layer of the fascia and the mucosa using separate stitches of resorbable 2/0
thread with vertical mattress sutures (Blair-Donati).
- Cut off any excess sling at the level of the obturator incisions.
- Separate the sling from the skin layers, and suture with a resorbable thread suture.
- Close the vaginal incision with interrupted sutures of gradually resorbable thread.
Transobturator procedure (Out-In approach) with the premium version
- Exteriorize the tip of the tunnelling device through the vaginal incision whilst holding the fi nger
against the tip to protect the urethra.
- Visually check that the tunnelling device has not transfi xed the vagina.
- Clip the cap of the sling to the extremity of the tunnelling device, an audible click will be heard, and
check that the cap is fi rmly attached to the tunnelling device.
- If using reusable tunnelling devices, it is advisable to use Kocher type forceps to unclip the cap and
turn it through a quarter-turn to the front or back.
- Separate the sling from the cutaneous planes, and secure using one absorbable suture.
Transobturator procedure (In-Out approach) with the premium version
- Clip the cap of the sling to the helical needle, a slight click is heard, and check that it is fi rmly at-
tached.
- Make a mini-incision with a scalpel to help the end of the helical needle out.
- To release the sling, either cut the sling at the level of the cap, or disconnect the cap from the helical
needle (it is advisable to use Kocher-type forceps and turn it through a quarter of a turn to the front or
back).
- Repeat the procedure with the second tunnelling device: clip the cap and perforate the tissues.
- To obtain correct tension in the sling, it is important to leave a visible space (3 to 5 mm) between the
urethra and the sling.
- Cut any excess sling fl ush with the obturator incisions.
- Separate the sling from the cutaneous planes, and secure using one absorbable suture.
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