Anatomic relationships of the tension-free vaginal mesh trocars

Objective: The objective of the study was to describe the distances between the major anatomic structures to the path of the tension-free vaginal mesh (TVM) trocars. Study Design: Four anterior transobturator and 2 posterior ischiorectal TVM trocars were inserted bilaterally into 8 fresh frozen cadavers. Dissections were performed and mean distances (95% confidence interval) were measured between the closest points along the trocar's path and significant anatomic structures. Results: The mean distances between both anterior transobturator trocars and the medial branch of the obturator vessels were 0.8 cm (range, 0.6 to 1.0) and 0.7 cm (range, 0.4 to 1.1), and bladder were 0.7 cm (range, 0.5 to 0.9) and 1.3 cm (range, 0.8 to 1.9), respectively. The mean distances between the posterior trocar and the rectum and inferior rectal vessels were 0.8 cm (range, 0.6 to 1.0) and 0.9 cm (range, 0.7 to 1.1), respectively. Conclusion: The bladder and medial branch of the obturator vessel may be at risk of injury during the passage of the anterior trocars, whereas the rectum and inferior rectal vessels may be at risk during the passage of the posterior trocar.