Advertisement

The anatomy of the sacral promontory

How to avoid complications of the sacrocolpopexy procedure
Published:January 02, 2018DOI:https://doi.org/10.1016/j.ajog.2017.12.236
      Because of problems with vaginal meshes and the high rate of recurrences of native tissue repair, more and more surgeons treat pelvic organ prolapse with laparoscopic sacrocolpopexy. This surgery requires skilled surgeons. The first step of sacrocolpopexy is the dissection of tissues in front of the sacral promontory to reach the anterior longitudinal ligament. Some complications can occur during this dissection and the attachment of the mesh. This step is dangerous for surgeons because of the proximity of vessels, nerves, and ureters. The lack of knowledge of anatomy can lead to severe complications such as vascular, ureteral, or nerve injuries. These complications can be life-threatening. To show anatomic concerns when surgeons dissect and affix the mesh on the anterior longitudinal ligament, we have developed a video of the promontory anatomy. By reviewing anatomic articles about vessels, nerves, and ureters in this localization, we propose an educational tool to increase the anatomic knowledge to avoid severe complications. In this video, we show an alternative location for dissection and graft fixation when the surgeon believes that mesh cannot be fixed safely on the anterior surface of S1, as currently recommended.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Claerhout F.
        • Verguts J.
        • Werbrouck E.
        • Veldman J.
        • Lewi P.
        • Deprest J.
        Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps.
        Int Urogynecol J. 2014; 25: 1185-1191
        • Cahill D.R.
        • Leonard R.J.
        • Marks Jr., S.C.
        Standards in health care and medical education.
        Clin Anat. 2000; 13: 150
        • Flynn M.K.
        • Romero A.A.
        • Amundsen C.L.
        • Weidner A.C.
        Vascular anatomy of the pre sacral space: a fresh tissue cadaver dissection.
        Am J Obstet Gynecol. 2005; 192: 1501-1505
        • Good M.M.
        • Abele T.A.
        • Balgobin S.
        • Montoya T.I.
        • McIntire D.
        • Corton M.M.
        Vascular and ureteral anatomy relative to the midsacral promontory.
        Am J Obstet Gynecol. 2013; 208: 486.e1-486.e7
        • Wieslander C.K.
        • Rahn D.D.
        • McIntire D.D.
        • et al.
        Vascular anatomy of the presacral space in unembalmed female cadavers.
        Am J Obstet Gynecol. 2006; 195: 1736-1741