Promedon STEEMA Instructions For Use Manual page 6

4. Sling placement: The needle enters into the incision site towards the
obturator foramen, bordering the ischiopubic branch until it reaches the
vaginal incision. The surgeon should guide the exteriorization process by
touching with his index finger to avoid urethral and vaginal mucosa injuries.
Thread the suture loop through the needle eyelet (see Figure 2), and pull back
the needle to pass the sling through the tunnel previously opened. Then,
release the sling loop from the needle tip.
Figure 2
5. Repeat Step 4 in the other obturator hole.
6. Sling without tension: Place the Metzenbaum scissors between the urethra
and the sling. Then, pull the suture loops, making sure the positioning tab is
located under the urethra, preventing the sling from folding.
7. Cut the ends of the sling/sheaths under the dilator arms and remove the
protective sheaths from both sides.
8. Remove the Metzembaum scissors.
9. Remove the positioning tab from the sling by cutting the thread located in
the front. Make sure to take out the positioning tab and the thread from the
vaginal channel.
10. Finally, cut the mesh excess and suture the incisions.
Postoperative care and therapy are at the surgeon's discretion.
In case a removal of implant is required, please note:
Polypropylene mesh integrate with patient's tissue, so complete removal may
be difficult.
In case a mesh removal is necessary due to pain, we recommend trying to cut
all the tension areas identified by the surgeon.
In most cases, the risk of organ injury caused by mesh removal may be higher
than the benefits resulting from this removal, so each case should be assessed
and decided at the surgeon's discretion.