Single-Incision Mini-Slings: Obturator Complex Pull-Out-Force Measurements.

Area of Science:

• Urogynecology
• Pelvic Floor Surgery
• Biomechanical Analysis

Background:

• Stress urinary incontinence (SUI) affects many women, with mini-sling procedures offering a minimally invasive treatment option.
• The stability of mini-sling anchors within pelvic anatomy is crucial for successful SUI treatment.
• Understanding the biomechanical properties of different mini-sling systems is essential for surgical decision-making.

Purpose of the Study:

• To compare the pull-out force of two mini-sling systems (MiniArc and Ajust) from the obturator membrane and obturator internus muscle.
• To evaluate the biomechanical stability of these systems in female cadaveric models.
• To determine which system offers superior anchorage for stress urinary incontinence treatment.

Main Methods:

• A prospective study utilizing 8 female cadaver pelvises.
• Pull-out force measurements were conducted using a force measurement device (PCE-FM50).
• Hooks from MiniArc and Ajust mini-sling kits were tested for their anchorage strength in the obturator membrane and obturator internus muscle.

Main Results:

• The Ajust mini-sling exhibited a significantly higher mean pull-out force (2,561.75 ± 638.8 g) from the complete obturator complex compared to the MiniArc (1,780.69 ± 442.3 g) (p = 0.025).
• No significant differences in pull-out force were observed between the two systems when anchored solely to the obturator membrane.
• These findings indicate differential biomechanical performance based on the specific anatomical structure targeted.

Conclusions:

• The Ajust mini-sling hook demonstrates more stable attachment to the obturator complex than the MiniArc hook.
• Both tested mini-sling systems provide sufficient anchorage to the evaluated anatomical structures for SUI treatment.
• The biomechanical data suggest potential differences in long-term efficacy related to anchor stability.