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
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References
- Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps.Int Urogynecol J. 2014; 25: 1185-1191
- Standards in health care and medical education.Clin Anat. 2000; 13: 150
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Article Info
Publication History
Published online: January 02, 2018
Accepted:
December 27,
2017
Received in revised form:
December 20,
2017
Received:
December 5,
2017
Footnotes
G.G. participates in workshop sessions for Olympus, Boston Scientific, and American Medical Systems; M.C. participates in clinical research for Coloplast, participates in workshops, expert meetings, and teaching lessons for Fresenius, Allergan, Olympus, Boston Scientific, and American Medical Systems, and has 2 patents in the field of pelvic synthetic mesh and genital prolapse surgery; A.P. has no conflict of interest.
In collaboration with Lyon 1 University, Lille 2 University, and 3D Medicus, with the financial support of Lille 2 University.
Cite this article as: Giraudet G, Protat A, Cosson M. The anatomy of the sacral promontory: How to avoid complications of the sacrocolpopexy procedure. Am J Obstet Gynecol 2018;218:457.e1-3.
Identification
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© 2018 Elsevier Inc. All rights reserved.
