The Single-Incision Mini Sling: Anatomical Considerations and Tips & Tricks

INTRODUCTION: Stress urinary incontinence (SUI) affects a large proportion of women, with an estimated 13% in the United States undergoing a surgical procedure for SUI during their lifetime. Traditional retropubic and transobturator midurethral slings are effective but involve longer trajectories, larger mesh loads (≈17–20 cm), and deeper dissection, often leading to greater postoperative pain, longer recovery, and patient concerns about sexual function. Single-incision mini-slings (SIMS), typically <8 cm in length, were developed to provide equivalent continence outcomes through a smaller vaginal incision and a less invasive trajectory, thereby improving recovery, reducing morbidity, and decreasing overall mesh burden. OBJECTIVE: To present an instructional surgical video demonstrating the placement of a single-incision midurethral sling for the treatment of SUI. The video highlights relevant pelvic anatomy, step-by-step technique, tips and tricks for tensioning and symmetry, and summarizes evidence regarding outcomes. METHODS: This is a purely instructional video combining high-definition operative footage and color-coded anatomical diagrams to illustrate sling placement. Key anatomical landmarks—including the urethra, obturator internus muscle, and arcus tendineus fascia pelvis—are identified, and critical neurovascular structures are highlighted. Placement of the static and dynamic sling anchors and tensioning maneuvers are shown in detail. RESULTS: Published randomized controlled trials (RCTs) demonstrate non-inferiority of SIMS compared with retropubic slings at 12–36 months of follow-up, including a 2024 multicenter RCT and a 2022 New England Journal of Medicine–published trial. Other studies report faster recovery, less postoperative pain, and improved sexual function with SIMS. The surgical approach is less invasive, quicker to perform, and carries a lower risk of trocar-related complications. It may be considered a good option for patients in whom avoidance of the retropubic space is desirable or those desiring a shorter recovery time. CONCLUSIONS: Single-incision mini-slings provide effective continence outcomes with meaningful patient benefits—including rapid recovery, improved sexual function, and decreased postoperative pain. They can additionally reduce the need for extensive dissection and lower overall mesh burden. Mastery of pelvic anatomy, adherence to tension-free principles, and careful patient selection are critical for success. This instructional video equips surgeons with the knowledge to safely and efficiently incorporate SIMS into their surgical armamentarium for the management of SUI.