Vascular and ureteral anatomy relative to the midsacral promontory

Good, Meadow M.; Abele, Travis A.; Balgobin, Sunil; Montoya, T. Ignacio; McIntire, Donald D.; Corton, Marlene M.

doi:10.1016/j.ajog.2013.02.039

Cited by 45 publications

(23 citation statements)

References 14 publications

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“…44 Pectopexy is a good option for patients with preoperative constipation, as it does not involve narrowing of the pelvic outlet that may cause defecation disorders. 20,21,28,39,44 Pectopexy is a novel technique, whereas sacropexy has been studied extensively; therefore, follow-up times differ between these procedures and no long-term outcomes were reported. According to National Institute for Health and Care Excellence guidelines, pectopexy should only be used in a research setting because of the limited current evidence regarding its safety and efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…The hypogastric nerves are located under the peritoneum to the left of the midline, the right ureter is 13 mm from the midsacral promontory (MSP), the left common iliac vein is 9 mm from the midline, the right common iliac artery is located 14-19 mm from MSP, and the middle sacral vessels remain near the midline. [18][19][20] Vessel injury can cause life-threating hemorrhage, whereas neural injury may result in the development of sexual and bowel dysfunction. Laparoscopic sacropexy (LS) is recommended in patients with apical prolapse after hysterectomy.…”

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confidence: 99%

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Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Szymczak

Grzybowska

Wydra

2019

Neurourology and Urodynamics

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Aims Apical defect is a pelvic organ prolapse disorder, with 5%‐15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). Methods A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. Results A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP‐Q < II stage) was 77%‐100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%‐97.6%, 71.0%‐100%, 66.7%‐87.8%, and 95%‐95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%‐12.8%. Conclusions Most studies reported anatomical and subjective outcomes, with follow‐up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Szymczak

Grzybowska

Wydra

2019

Neurourology and Urodynamics

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“…Flynn et al (2005) showed that the left CIV was located as close as 3 mm to the midline at the sacral promontory. A recent study revealed that the right ureter, right common iliac artery, and left CIV were all found within 3 cm of the midsacral promontory (Good et al, 2013). A recent study revealed that the right ureter, right common iliac artery, and left CIV were all found within 3 cm of the midsacral promontory (Good et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

et al. 2014

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The purpose of this study was to classify anatomical variations of the internal iliac vein (IIV) in relation to robotic or laparoscopic extended lymphadenectomy. Between March 2011 and July 2012, 60 consecutive patients underwent robotic or laparoscopic extended lymphadenectomy. We retrospectively reviewed surgical video clips and analyzed the pattern of the IIVs in the presacral area. IIV variations were classified into seven types: Type A, normal (n = 39, 65.0%); Type A with a dilated middle sacral vein (n = 5, 8.3%); Type B, left IIV connecting centrally to the left external iliac vein (n = 5, 8.3%); Type C, a separated trunk of the left IIV draining into the left central common iliac vein (CIV; n = 1, 1.7%); Type D, a separated trunk of the right IIV draining into the left central CIV (n = 8, 13.3%); Type E, a separated trunk of the right IIV draining into the right central CIV (n = 0, 0%); and Type F, separated trunks of the bilateral IIV connecting with each other before draining into the left central CIV (n = 2, 3.3%). The prevalence of IIV anomalies was 26.7%; the incidence of separated IIV trunks was 18.3%. To prevent life-threatening IIV injury during extended lymphadenectomy or sacral colpopexy, the anatomical variations of the IIVs should be known exactly.

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“…Injury of a vessel can be very dangerous, carrying a heavy burden to surgeons. In addition, the ureter is very close to the midsacral promontory, which is a landmark for sacrocolpopexy and its location varies among patients [6] (Fig. 2) [5].…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…According to a prior study comparing ICG and ASC, both procedures achieved restoration of normal anatomy and improvement of related symptoms [6]. However, because there are less vessels and nerves close to the operating site in ICG than in ASC, ICG might be a good alternative to ASC.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical treatments for vaginal apical prolapse

Kong

Bai

2016

Obstet Gynecol Sci

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Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits.

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Vascular and ureteral anatomy relative to the midsacral promontory

Cited by 45 publications

References 14 publications

Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

Surgical treatments for vaginal apical prolapse

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