A Novel Access to the Sacrospinous Ligament and the Coccygeal Muscle

Abstract

<h3>Study Objective</h3> This study aimed to describe a novel access route to the sacrospinous ligament and the coccygeal muscle. The overarching goal was to show our team's standard systematization to this technique and state it's safety in low parametric injuries. <h3>Design</h3> Video description of the novel technique with clear illustrations of each step. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> The surgery was performed in a 27-year-old woman who suffered from deep endometriosis in the pelvic floor. Her diagnosis was performed through physical examination, with innervation compression symptoms, ultrasound and MRI imaging techniques. <h3>Interventions</h3> After the identification and release of the central structures, we proceed to the lateral approach with the isolation of the internal iliac artery, which should be medially tractioned, enabling the identification of the bifurcation of the common iliac vein into the internal and external iliac vein. We then start the systematization of the approach with the dissection of the avascular space between the "V" shape formed by the umbilical artery and uterine artery, subsequently heading towards the sacrum. Next, we identify the rectovaginal fascia, being the first structure to be identified, extending from the rectovaginal space to the tendon arch. Behind this structure, we can find the coccygeal muscle and the sacrospinous ligament extending from the sciatic spine towards the sacrococcyx. <h3>Measurements and Main Results</h3> We conclude the systematization of the pelvic floor approach being able to safely perform the resection of the endometriotic nodules with intact innervation, tension-free muscles and greater damage control. <h3>Conclusion</h3> In summary this novel approach to the pelvic floor is thought to be a simpler and less risky alternative to treat low parametric injuries afflicting the sacrospinous ligament and the coccygeal muscle.