TOT Needle Path

TRANSOBTURATOR VAGINAL TAPE: INSIDE-OUT (TVT-O) Background In 2003, de Leval described a modified transobturator approach, in which the tape is inserted from the suburethral incision to the skin incisions. That modification was named by the author as the inside-out transobturator vaginal tape procedure (TVT-O) (Fig. 9) (15). His main objective was to reduce the risk of bladder and/or urethral injuries, which were occasionally reported with the original TOT technique (38,40-41).