A set of 2 specific needles are used to pass through the skin incision and then rotated to perforate the obturator membrane
along with its both external and internal obturator muscles and keeping close contact with the bone, turns around the ischiococcygeus ramus.(Fig.1-7) A finger tip is introduced in the space between the vaginal flap and urethra up to the pelvic fascia and waits for the tip of the needle to come.
A thin fibrous sheet, the obturator membrane
, is attached to the margin of the obturator foramen.
Karram responds: If there continues to be granulation tissue and bleeding into the vagina, then the mesh that is causing the problem is most likely to lie on the vaginal side of the obturator membrane
, so I do not think that a thigh or abdominal approach will allow access to the problematic mesh.