This patient is a 46-year-old woman from Oregon who had a TOT sling inserted in 2010. (Figure 1) Immediately after surgery, she felt there was something wrong as her vagina felt tight and she could not close her legs. Three months later, she went back to the implanting gynecologist and the physician cut the sling which helped with vaginal tension. (Figure 2)

 

Figure 1 - Normal TOT Sling

Figure 1 – Normal TOT Sling

Figure 2: TOT Sling Removal

Figure 2: TOT Sling Suburethral Removal

Figure 3: Figure 2: TOT Sling Lateral Removal

Figure 3: TOT Sling Lateral Removal

 

Chronologic events of patient listed below:

2010                 TOT sling implanted – Gynecologist

2010                 TOT sling cut – Gynecologist

2012                 TOT sling cut again at University of Tennessee – Urogynecologist (Figure 2)

2016                 Houston TX –    Physical Therapy

2017                 MAYO CLINIC – MN – 12-inch Abdominal Incision

 

After 2 revision surgeries and removing only 1 cm of mesh this patient continued to suffer from pain which scored a 10/10 pain daily. (Figure 2) This patient was referred to the MAYO CLINIC in Minnesota by her implanting physician.

At Mayo Clinic, she was taken to the operating room where she underwent a 3-hour operation. This patient received both vaginal and an abdominal incision. The abdominal incision was 12 inches long. The surgeons at the Mayo Clinc were only able to remove 1 cm of mesh.

NOTE from Dr. Miklos:  It is impossible to remove a TOT sling through an abdominal incision. This incision and surgery should have never been attempted by the Mayo Clinic surgeon.

This patient came to Atlanta in 2018 for a next day surgery. Dr. Miklos removed all the mesh (Figure 3) using vaginal and groin in incisions (Figure 4). The inguinal or groin incision coupled with a vaginal incision is the only way to remove the TOT sling. Drs. Miklos & Moore removed the remaining 12 cm of mesh from her body. (Figure 5)

 

Figure 4: Mesh extraction from the groin

Figure 4: Mesh extraction from the groin

Figure 5: Mesh Extracted

Figure 5: Mesh Extracted

 

Since this patient’s mesh removal her pain has gone from 6/10 at rest and 10/10 with activity to 0/10 left groin and 3/10 on the right groin. After 4 surgical procedures, 5 states, and more than 8 doctors she finally feels almost normal again. She claims the surgery has changed her life.

Miklos & Moore Words of Wisdom:

  1. TOT slings implanted are usually between 10-16 cm in length.
  2. TOT slings should be completely removed if you have vaginal and groin pain.
  3. TOT slings giving only vaginal pain and painful intercourse usually require that only the vaginal portion of the sling be removed (5-6 cm).
  4. TOT slings can NOT be removed via an abdominal incision or by laparoscopy.
  5. Removal of the whole TOT slings can only be done through a vaginal and groin incision.