TiLOOP® Tape

IImplantation

Choice between retropubic and trans-obturator access. With retropubic access, the sling lies in the central section of the urethra, with trans-obturator access in the anterior section.  Needle applicators are used for the insertion. The choice of access for an individual patient is at the discretion of the experienced surgeon. 

Procedural options

TVT insertion through an approx. 1 cm incision at the anterior vaginal wall in the central section of the urethra. The needle applicators are fed transvaginally and retropubically to exit suprasymphrasarily (downside-up technique). The adjustment is always performed without tension. Suprasymphysary to vaginal access is similiar but in the reverse order (upside-down technique). 

TVT insertion through an approx. 1 cm incision at the anterior vaginal wall in the anterior to central section of the urethra. The needles are then fed transvaginally and behind the pubic ramus through the obturator foramen and then penetrate the skin approx. 2 cm laterally to the labia major (inside-out technique). The adjustment is always performed without tension. The direct introduction through the obturator foramen towards the vagina is done similarly but in the reverse order (outside-in technique).

Titanisation

Chemical vapour deposition (CVD) is a process for the metallisation of complex components while at the same time achieving strong bonds. However, as this process involves temperatures in excess of 150°C, it is not an option for many prosthetic materials which would not be shape retentive at such temperatures (e.g. polypropylene). 

For that reason, the titanisation of plastic implants takes place at low temperatures using a special plasma-coating process known as PACVD (plasma-activated chemical vapour deposition).

Plasma is the term used for an excited (ionised) gas. In that stage, atoms/molecules are highly energetic. However, plasma is not hot. In everyday life, we are familiar with plasma in fluorescent tubes. The electrically charged gas components emit light as the result of their highly energetic state, but the fluorescent tube remains cold. 

In the titanisation process, gaseous titanium is introduced into the coating chamber as a precursor. By adding energy in form of plasma, the precursor is split into individual ionised atoms. These ionised titanium atoms have free electrons at their surfaces.

In addition to the precursor, the plasma also excites the surfaces of the plastic implants with the result that their surfaces also have free electrons. The ionised titanium atoms come into contact with the ionised surface of the implant resulting in the formation of covalent bonds with the free electrons. Covalent bonds are seen as the strongest of chemical bonds; the titanium is thus almost permanently bonded to the plastic.

This process creates a composite material whose surface is coated with an ultra-thin, approx. 30–50 nm (1 nanometre = 1 millionth of a millimetre), highly biocompatible layer of titanium. The coating is so thin that it appears to be transparent and is also highly flexible.

Because the titanium precursor is introduced in gaseous form, it reaches all parts of the plastic implant. As the result, the entire surface, including gaps in between complex shapes, is completely and evenly titanised.