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How we perform a posterior sacrospinous ligament fixation by the vaginal route

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Abstract

Posterior sacrospinous fixation (SSF) was first described by Amreich in 1950 and then modified by Richter in 1968. The main difficulty of this technique is the pararectal approach with dissection under visual guidance. Our aim was to teach young surgeons to use this alternative technique for apical suspension and to facilitate the pararectal approach. We divide the sacrospinous ligament fixation technique into ten surgical steps: exposure, infiltration, vaginal incision, recto-vaginal dissection, pararectal dissection, SSL suture, vaginal fixation (with vaginal strips), vaginal closure, SSF and final closure. We have performed > 500 SSFs following the sacrospinous ligament fixation technique. Inexperienced surgeons are generally not comfortable with the dissection of the SSL. A video of the procedure with pararectal dissection, SSL identification and suturing clearly shown can help to perform this technique. The use of vaginal strips has been designed to help strengthen the vaginal part of the SSF. It is important to share such a video showing how to approach the pararectal fossa with a dissection under visual guidance. The aim is to help young surgeons better understand the surgical technique and dissection.

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Authors and Affiliations

  1. Department of Gynaecology, Jeanne de Flandre University Hospital, Lille, France

    Estelle Declas, Geraldine Giraudet, Sophie Delplanque, Chrystèle Rubod & Michel Cosson

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  1. Estelle Declas
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  2. Geraldine Giraudet
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  3. Sophie Delplanque
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  4. Chrystèle Rubod
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  5. Michel Cosson
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Correspondence to Estelle Declas.

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Conflicts of interest

Michel Cosson has several conflicts of interest including:

Participation on the medical board of Boston Scientific, Laborie workshop.

Surgical teaching sessions for Boston Scientific four times a year and for Coloplast two times a year.

Research with patient participation in the field of urogynecology for synthetic meshes, modeling of the female pelvic cavity and obstetrical sensors with public fundings.

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Written informed consents were obtained from the patients for publication of this video article and any accompanying images in the Urogynecology journal.

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Declas, E., Giraudet, G., Delplanque, S. et al. How we perform a posterior sacrospinous ligament fixation by the vaginal route. Int Urogynecol J 31, 1479–1481 (2020). https://doi.org/10.1007/s00192-019-04149-8

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  • DOI: https://doi.org/10.1007/s00192-019-04149-8

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