Anterior sacrospinous ligament fixation associated with paravaginal repair using the Pinnacle™ device: an anatomical study

Cayrac, Mélanie; Letouzey, V.; Ouzaïd, I.; Costa, P.; Delmas, V.; Tayrac, Renaud de

doi:10.1007/s00192-011-1554-5

Cited by 15 publications

(6 citation statements)

References 16 publications

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“…Cayrac reported that 50% of Pinnacle tips were properly placed in the sacrospinous ligament in a cadaveric study. 12 If our study found a similar outcome, we could estimate a 50% incorrect placement rate with a 95% CI of 28-72%. The 6-month follow-up period was chosen because it was felt that any migration of the tip would most likely occur within the first months after surgery, before complete wound healing.…”

Section: Methodsmentioning

confidence: 62%

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Anchor placement and subsequent movement in a mesh kit with self‐fixating tips: 6‐month follow‐up of a prospective cohort

Brennand

Bhayana

Tang

et al. 2014

BJOG

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Objective To describe the initial placement of Elevate single-incision mesh kit device tips relative to the sacrospinous ligament, and to measure tip movement over a 6-month period from initial placement. Design Prospective cohort.Setting Tertiary care urogynaecology centre in Calgary, Canada.Population Women electing for surgical management of anterior vaginal wall prolapse.Methods Ten women underwent anterior prolapse repair using the Elevate single-incision mesh kit with a metallic fiducial marker attached to the tips of the surgical device. Women were imaged by magnetic resonance imaging (MRI) within 48 hours of surgery, and again 6 months later to investigate the position of the device tips and change ≥4 mm over the 6-month postoperative period.Main outcome measure(s) Position of self-fixating tips within 48 hours of surgery, and at six months post-operative.Results Anchor insertion was directly into the sacrospinous ligament in 10 of 20 insertion points (50%, 95% CI 27-73%).Movement was most often noted in the cranial-caudal direction: a change in location of ≥4 mm was observed for 8/20 anchors (40%, 95% CI 19-64%). Cranial-caudal movement was observed less frequently among sacrospinous anchors than among anchors inserted into other pelvic structures (1/10 versus 7/10, P = 0.020, difference in proportion À60%, 95% CI À94 to À26%). PFDI-20 scores improved statistically significantly by 6 months (P = 0.008, mean change À62.9%, 95% CI À105.1 to À20.7%), but PFIQ-7 scores did not change statistically significantly over the same time period (P = 0.523, mean change À12.4%, 95% CI À54.5 to 29.8%).Conclusions The novel self-fixating anchoring tips of this single-incision mesh kit do not reliably anchor into the sacrospinous ligament. The tips have been shown to move with time, although not all cases of anchor movement were associated with recurrent prolapse.

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Section: Methodsmentioning

confidence: 62%

“…PFDI-20 scores improved for all ten women. Median PISQ-12 scores improved for the four women who were sexually active (26 versus 13; IQR 23-41 versus IQR [12][13][14], although tests of statistical significance were not performed because of the small sample size. …”

Section: Resultsmentioning

confidence: 99%

Anchor placement and subsequent movement in a mesh kit with self‐fixating tips: 6‐month follow‐up of a prospective cohort

Brennand

Bhayana

Tang

et al. 2014

BJOG

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“…In most of the publications, it is recommended in sacrospinous -sacrotuberous fixation to place the sutures at a distance at least 20 mm medial to the ischial spine and put the suture near to the lower than the upper border of the SSL to avoid injury of the pudendal nerve. 10 In a cadaveric study, Manning and Arnold concluded that the vascular and nerve anatomy behind and in the vicinity of the sacrospinous ligament is enormously variable and that suture placement two fingerbreadths medial to the spine does not guarantee safety. 11 In this modified technique, we are essentially making use of the sacrospinous/sacrotuberous complex.…”

Section: Discussionmentioning

confidence: 99%

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Sweed¹,

Mostafa²,

Sammour³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

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“…Kasyanet al described ureteral injury which was diagnosed after surgery but revealed urine leakage extending to the inter-fascial space of the right hip suggesting intra operative direct injury to the ureter secondary to dissection and not kinking [10]. Cayrac et al in his cadaver study confirmed that the ureter can be twisted because of the mesh traction [11]. Doucede et al describe ureteral injury after placement of Uphold ™ mesh [5].…”

Section: Discussionmentioning

confidence: 99%

Ureteral Obstruction Secondary to Vaginal Implant

Levy

Beck

Raz

et al. 2019

COGO

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Introduction: Ureteral obstruction following vaginal mesh placement is a rare complication.Hypothesis: We propose a mechanism of traction of the bladder neck as a cause for ureteral kinking and obstruction.Methods: In this report we describe two surgical cases using vaginal mesh implant which presented with ureteral obstruction two days following the procedure.Results: The patients were treated using temporary ureteral stents without removal of the implant.Conclusion: Controlled tension of the implant during the procedure and routine diagnostic cystoscopy can prevent the complication.Brief summary: Ureteral obstruction following vaginal implant treated with ureteral stents. A mechanism of traction of the bladder neck as a cause for ureteral obstruction is proposed.

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Anterior sacrospinous ligament fixation associated with paravaginal repair using the Pinnacle™ device: an anatomical study

Abstract: Anterior SSL fixation associated with paravaginal repair using the Pinnacle™ device was not reproducible every time in this cadaver study. These results confirm the need for specific training before starting anterior SSL fixations.

Cited by 15 publications

References 16 publications

Anchor placement and subsequent movement in a mesh kit with self‐fixating tips: 6‐month follow‐up of a prospective cohort

Anchor placement and subsequent movement in a mesh kit with self‐fixating tips: 6‐month follow‐up of a prospective cohort

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Ureteral Obstruction Secondary to Vaginal Implant

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