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How we do an anterior sacrospinous ligament fixation for vaginal vault prolapse

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Abstract

Since 2019, all vaginal mesh implants were removed from the market. Since, surgeons have only the autologous technique left to treat prolapse by vaginal route. The anterior sacrospinofixation is an alternative technique to treat vaginally apical prolapses. We have divided the anterior sacrospinous ligament fixation technique into 10 surgical steps: exposure, infiltration, vaginal incision, vesico-vaginal dissection, paravesical dissection, sacrospinous ligament suture (two passage in the SSL on each side, using a suture-capturing device), vaginal fixation, vaginal closure, sacrospinous ligament fixation and final closure. We have performed more than 50 ASSF. This technique is not very well known, and the surgeons are more used to approach the SSL by posterior way. We have included a video of the procedure and an anatomical drawing exhibiting the dissection of the SSL without eyes control. We also added tips and tricks to easily apprehend this new technique. The anterior approach seems to has several advantages compared to the traditional posterior technique. We want to share such a video on showing how to approach the paravesical fossa anteriorly without eyes control.

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Abbreviations

SSF:

Sacrospino-fixation

ASSF:

Anterior sacrospinofixation

PSSF:

Posterior sacrospinofixation

SSL:

Sacrospinous ligament

References

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Authors and Affiliations

  1. Department of Gynaecology, Jeanne de Flandre University Hospital, 49 rue de Valmy 5900, Lille, France

    Estelle Declas, Geraldine Giraudet, Celine De Graer, Cyril Bengler, Sophie Delplanque & Michel Cosson

Authors
  1. Estelle Declas
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  2. Geraldine Giraudet
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  3. Celine De Graer
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  4. Cyril Bengler
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  5. Sophie Delplanque
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  6. Michel Cosson
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Contributions

E Declas: Manuscript writing.

G Giraudet: Data collection, Project development.

C De Graer: Data collection, Project development.

S Deplanque: Data collection, Project development.

M Michel: Data Collection, Project development.

All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Estelle Declas.

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Conflicts of interest

Michel Cosson has several conflicts of interest including:

Participation to medical board for Boston Scientific, workshop Laborie.

Surgical teaching sessions for Boston Scientific 4 times a year and for Coloplast 2 times a year.

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

Géraldine Giraudet participates at workshops sessions for Olympus, Boston Scientific and Coloplast, paid symposium for Applied.

Remaining authors claim no conflict of interest.

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Declas, E., Giraudet, G., De Graer, C. et al. How we do an anterior sacrospinous ligament fixation for vaginal vault prolapse. Int Urogynecol J 32, 3305–3308 (2021). https://doi.org/10.1007/s00192-021-04863-2

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  • DOI: https://doi.org/10.1007/s00192-021-04863-2

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