Promedon Calistair S Instructions D'utilisation page 8

the handle down. Perform the procedure accordingly on the contralateral
site by using the left hand for pushing the RIG and the right index finger for
palpating the RIGs direction.
NOTE: DO NOT rotate the RIG since the intended position of the
anchor is NOT the obturator membrane.
Ensure that the AAA is firmly attached to internal obturator muscle by gently
pulling on the AAA's looped sutures. The sutures can subsequently be cut
and removed once the final position of the anchors and mesh are confirmed.
NOTE: Ensure that the mesh is not twisted and positioned horizontal
to the bladder neck.
NOTE: Ensure a tension-free implantation technique. If required, the
AAA arms can be loosened or released by firmly pulling on the AAA
looped sutures.
NOTE: A cystoscopy may be required if bladder perforation is
suspected.
The central part of the mesh is attached by two absorbable sutures close to
the bladder neck to prevent displacement.
Optional procedure:
In patients with uterus, the posterior semicircle of the central mesh part
should be cut away with scissors. The safety and performance of the implant
are not affected by this procedure.
The posterior central part of the mesh is attached with two non-absorbable
sutures to the pericervical ring, or in case of hysterectomy, to the remnants
of the cardinal ligaments.
The TAS suture ends are led through the pores of the corresponding
posterior mesh arms. For this purpose, select the outer distal part of the
mesh arm in order to ensure a tension free implantation of the mesh.
Since the sutures are already attached to the sacrospinous ligament by the
anchors, ensure that the suture ends are guided from the posterior to the
anterior aspect of the mesh arm.
NOTE: Ensure that the mesh (arm) is not twisted.
Slide the posterior mesh arm to the sacrospinous ligament bilaterally. Hold
on to the end of the TAS suture during this procedure. Subsequently,
knot the posterior mesh arms to the sacrospinous ligament with the
corresponding sutures on both sides respectively. The Knot Pusher can be
utilised for this step as and when required. Closure of the vagina according
to the surgeon's standard procedure. Vaginal packing for app. 24h is
recommended.
NOTE: Limit the trimming of the vaginal epithelium in order to
minimise the risk of vaginal stricture formation (i.e. contraction) since
this may cause dyspareunia and pain.
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