The minimally invasive sacrospinous fixation under visual guidance: An anatomical study

Abstract

Objective: Sacrospinous fixation is the gold standard procedure for management of apical pelvic organ prolapse by the vaginal route. However, there may be a relevant risk of neurovascular injury due to the proximity of neurovascular structures. We propose an anatomical study concerning the sacrospinous ligament with a new innovative minimally invasive technology using both a suture capturing device and a chip-on-the-tip endoscope to perform sacropinous fixation.

Study design: Bilateral sacrospinous fixation was performed in three female cadavers, in the course of the anatomical study conducted with a specific device (the Suture Capturing I Stitch™ Device) under real time visual guidance with a chip-on -the-tip endoscope, the NanoScope™ system.

Results: Identification of ischial spine and sacrospinous ligament as well as feasibility of sacrospinous fixation under NanoScope™ control were always possible on both sides.

Conclusions: This new innovative minimally invasive technology using both a suture capturing device and a chip-on-the-tip endoscope is relevant and could be an advantage in terms of safety and better placement of the suture on the sacrospinous ligament.

Keywords: Anatomy; Pelvic organ prolapse; Pudendal nerve; Sacrospinous fixation; Sacrospinous ligament; Vaginal vault prolapse.