In this new blog our Curator, Louise Wilkie, explains more about the new surgical device that has been donated to the museum and the significance behind it.
Surgeons’ Hall Museums, for the first time since the 1990s, has accepted contemporary human tissue into our collections. The unique donated surgical device highlights the possible complications associated with the TVT procedure and is a physical and poignant reminder of a significant period in women’s health.
Surgeons Hall Museums opened in 1832 as a teaching museum and educational resource for surgeons. For a hundred and fifty years the specimen collections flourished, as new pathologies and surgical techniques were discovered. The specimens offered surgeons a chance to record and study these developments and the museum expanded to have one of the largest pathology collections in the UK. As new technologies, teaching methods and teaching aids developed, the need for the pathology collections at the museum declined in the latter half of the 20th Century.
With no new pathology entering the museum from the 1990s onwards, the purpose of the museum was to dramatically change. In 2015 the museum was completely transformed with education of the public at the forefront. The pathology collections now offer the public the opportunity to see inside the human body, learn what and how pathologies develop, alongside the surgical interventions used throughout the centuries to combat this. In addition, the pathology collections are still used in various medical research projects, alongside historical medical investigations.
As a result of this decline in use of the pathology collections for surgical education, the museum’s Collection Development Policy (a document/plan which lays out the museums collecting priorities and needs) now states that the collections are ‘closed to human remains specimens’. Nevertheless, as one of the few museums in Scotland, that not only has legal permission to care and display contemporary human remains but also has the in-house specialties to conserve and curate these delicate collections, the museum has always felt a responsibility to agree to consider each offer of new specimens on a case-by-case basis.
This new specimen donation is an excellent example of why we do just that. The donor was awaiting surgery to remove her mesh implant due to a variety of complications. The donor wanted the mesh implant to be preserved in a collection which is both protected and accessible, so that the specimen will always be available to future researchers. The museum holds both Accreditation and Recognition Status and as such our actions as a museum are held to the highest standards of the heritage sector. As our collections are deemed to be of National Significance and importance to the people and heritage of Scotland, they are safeguarded and as such would not be disposed of unless in the unique circumstances such as Repatriation or deterioration beyond repair. We are delighted that because of our reputation, the donor knew her specimen would remain safe and preserved with us and as such has entrusted it into our care.
In this unique case it was the patient who approached the museum for donation, not, as traditionally was the case, the hospital or medical community. As such the museum had to investigate the legality of the donation, create new donor consent forms to ensure the process was ethical, and discuss the process with the operating surgeon and hospital. The real driving force behind this donation was the patient donor’s wishes and the unique circumstances surrounding the device.
This specimen shows a Tension free Transvaginal Tape (usually made from synthetic polypropylene) and attached tissue measuring 25cm that was surgically removed from the donor in April 2022 due to complications, it was surgically inserted in 2006. The TVT procedure was introduced in the 1990s as a new minimally invasive surgical treatment for Stress Urinary Incontinence (SUI), a condition which is a very common problem in women. The British Association of Urological Surgeons estimates that just under 24,000 surgeries took place for treatment of SUI between 2014 and 2016 in the UK.[1] Often presented as the ‘gold standard’, it is estimated that around 10,000 of SUI cases between 2006 – 2016 used the TVT procedure.[2] The mesh is introduced via a curved trocar and is used as a sling under the urethra to reinforce the weakened ligaments. This procedure is most often performed ‘blind’ and due to the minimally invasive technique, patients can be discharged quicker than with traditional approaches.
Other treatment for SUI includes, Colposuspension which involves making a cut in the lower abdomen, liftin the neck of the bladder and stitching it into this lifted position. This procedure is preformed either in open surgery or laparoscopically. There is also another form of sling surgery but instead of using synthetic material, the sling is made from the patient’s tissue. This sling procedure unlike the TVT approach involves a more invasive approach. So, it is easy to understand why the TVT procedure was once very popular, it is extremely efficient to undertake with less in hospital recovery time.
Short-term results illustrated TVT Procedure were very successful, but it is now clear that major complications can arise from the TVT Procedure. So much so that the Scottish Government called for a halt in the use of transvaginal mesh in 2018 and conducted a review. As such the NHS has currently paused the use of this technique in the UK unless no other option is suitable.
At the moment, it is not possible to have vaginal mesh surgery for urinary incontinence on the NHS unless there’s no alternative and the procedure cannot be delayed, and after detailed discussion between you and a doctor. NHS UK [3]
The types of complications with TVT procedures can include, long-lasting pain and nerve damage, incontinence, sexual problems, erosion injury to the bladder or bowel, and mesh exposure through vaginal tissue.
Significant problems faced early patients with complications, including issues and delays surrounding patient advocacy when post operative concerns were first raised and a lack of surgeons in the UK trained in TVT removal surgery. To address the issue the Scottish Government introduced the Complex Pelvic Mesh Removal Service hosted by NHS Greater Glasgow and Clyde and similar NHS centres were opened in England. A national fund was also established to offer monetary support of up to £1000 per sufferer and now the Government will also cover costs of patients, who sought or wish to seek surgical removal in private practice, rather than wait on the NHS.
There is still not a clear idea of how many women experience complication from the TVT Procedure with percentages ranging from 1-3% up to 10%. This number might appear low in percentages terms, but what these complications have highlighted are serious questions surrounding the introduction and promotion of the TVT Procedure, informed patient consent (were all treatment options equally presented) and latterly and perhaps most importantly concerns on how patient concerns over post-operative symptoms were addressed (patient advocacy).
The donated mesh stands as a permanent reminder of this moment in women’s health, continuing medical technology and surgical innovation and as such should be safeguarded for future research and display. It was the wishes of the patient, who had experienced significant physical complications and the emotional impact that accompanies such trauma, who advocated for this specimen to remain in an independent museum as a physical reminder of these events, in the hope that it will benefit future generations.
The device is now on display in Surgeons’ Hall Museums Wohl Pathology gallery.
The museum is bound by strict rules on what and how we collect and as such will only consider human remains donations on a case-by-case basis and only when those remains have been ethically sourced and benefit the wider collection polices.
[3] surgery and procedures for urinary incontinence – NHS (www.nhs.uk)
The Anatomy Lab 
Great exhibition. I think it would be more dramatic if displayed next to the TVT implant kit, needles and all.
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Hi Sam! We are currently trying to get an unused implant to put on display beside the surgically removed one.
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