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Urinary Incontinence
Figure 5: Anchoring into the Ipsilateral Vaginal Apex
most concentrated in its medial portion.
15
Sciatic nerve irritation after
sacrospinous suspension has been described as a new-onset problem
16
and as an exacerbation of previous symptoms.
3
Serious vascular injury is a rare complication of sacrospinous ligament
suspension. To effectively manage pelvic haemorrhage, familiarity with
the surrounding anatomical landmarks is essential. Verdeja et al.
17
demonstrated that the pudendal neurovascular bundle ranges in
location from 0.9 to 1.3cm medial to the ischial spine; the sciatic nerve
is located 3.1–3.3cm medial to the spine. Based on these anatomical
relationships, the sacrospinous ligament would appear to be most
vulnerable along its lateral third. Yet another series of cadaver
dissections, performed by Barksdale et al.,
18
showed the pudendal
neurovascular bundle to be relatively shielded from injury by the ischial
spine and sacrospinous ligament. The inferior gluteal artery, with a
more perpendicular course relative to the ligament, was the vascular
structure whose location appeared most vulnerable to injury. The
authors refer to three elements of the operation that may carry
particular risk: suture placement along the posterior ligament;
retractor placement beyond the ligament; and overly aggressive
© 2007 Boston Scientific Corporation or its affiliates. All rights reserved.
denuding of the ligament surface.
Figure 6: Trocar-free Application of Grafts
Throughout 16 years of experience performing sacrospinous ligament
suspension procedures at our centre, haemorrhage from the ligament
or coccygeus muscle has been observed as an exceedingly rare event. In
using the Capio device over the past eight years at our referral centre,
we have not had a single major vascular or neurological injury – the
safety profile of this device has been proved to be excellent.
Furthermore, avoidance of deep vaginal retractors using the Capio
technique has sharply reduced the observed complaints of nerve
irritation that used to result from overzealous retraction against the
rectum and presacral area.
Conclusions
The Capio technique for sacrospinous suspension has evolved into a
procedure with little resemblance to traditional ‘posterior’ sacrospinous
repair in terms of invasiveness, anatomical outcome, operative time and
morbidity. We have found this approach to be appropriate for the
majority of women presenting with apical prolapse, resulting in highly
favourable anatomical outcomes with minimal surgical morbidity.
The above article expresses the opinions of the author and does not
© 2007 Boston Scientific Corporation or its affiliates. All rights reserved.
necessarily reflect the opinion of Boston Scientific. ■
1. Sederl J, Zur operation des prolapses der blind endigenden 8. Miyazaki FS, Miya hook ligature carrier for sacrospinous 14. Alevizon SJ, Finan MA, Sacrospinous colpopexy: management
sheiden, Geburtshilfe Frauenheilkd, 1958;18:824–8. ligament suspension, Obstet Gynecol, 1987;70:286–8. of post-operative pudendal nerve entrapment, Obstet Gynecol,
2. Sze EHM, Karram MM, Transvaginal repair of vault prolapse: A 9. Lind LR, Shoe J, Bhatia NN, An in-line suturing device to 1996;88:713–15.
review, Obstet Gynecol, 1997;89:466–75. simplify sacrospinous vaginal vault suspension, Obstet Gynecol, 15. Barksdale PA, Gasser RF, Gauthier CM, et al., Intraligamentous
3. Morley GW, DeLancey JOL, Sacrospinous ligament fixation for 1997;89(1):129–32. nerves as a potential source of pain after sacrospinous ligament
eversion of the vagina, An J Obstet Gynecol, 1988;158:872–81. 10. Shull BL, Capen CV, Riggs MW, Kuehl TJ, Pre-operative and fixation of the vaginal apex, Int Urogynecol J Pelvic Floor
4. Hardiman PJ, Drutz HP, Sacrospinous vault suspension and post-operative analysis of site-specific pelvic support defects in Dysfunct, 1997;8(3):121–5.
abdominal colposacropexy: Success rates and complications, Am 81 women treated with sacrospinous ligament suspension and 16. Lantzsch T, Geopel C, Wolters M, et al., Sacrospinous ligament
J Obstet Gynecol, 1996;175:612–16. pelvic reconstruction, Am J Obstet Gynecol, 1992;166:1764–7. fixation for vaginal vault prolapse, Arch Gynecol Obstet,
5. Shull BL, Capen CV, Riggs MW, Kuehl TJ, Pre-operative and 11. Goldberg RP, Tomezsko JE, Winkler HA, et al., Anterior or 2001;265(1):21–5.
post-operative analysis of site-specific pelvic support defects in posterior sacrospinous vaginal vault suspension: long-term 17. Verdeja AM, Elkins TE, Odoi A, et al., Transvaginal
81 women treated with sacrospinous ligament suspension and anatomic and functional evaluation, Obstet Gynecol, 2001;98: sacrospinous colpopexy: anatomic landmarks to be aware of to
pelvic reconstruction, Am J Obstet Gynecol, 1992;166:1764–71. 199–204. minimise complications, Am J Obstet Gynecol, 1995;173:
6. Nichols DH, Sacrospinous fixation for massive eversion of the 12. Guner H, Noyan V, Tiras MB, et al., Transvaginal sacrospinous 1468–9.
vagina, Am J Obstet Gynecol, 1982;142:901–4. colpopexy for marked uterovaginal and vault prolapse, Int J 18. Barksdale PA, Elkins TE, Sanders CK, et al., An anatomic
7. Winkler HA, Tomeszko JE, Sand PK, Anterior sacrospinous Gynaecol Obstet, 2001;74(2):165–70. approach to pelvic haemorrhage during sacrospinous ligament
vaginal vault suspension for prolapse, Obstet Gynecol, 13. Cespedes RD, Anterior approach bilateral sacrospinous ligament fixation of the vaginal vault, Obstet Gynecol, 1998;91:715–18.
2000;95:612–15. fixation for vaginal vault prolapse, Urology, 2000;56:70–75.
84 EUROPEAN GENITO-URINARY DISEASE 2007
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