Transvaginal sacrospinous colpopexy by palpation—a new minimally invasive procedure using an anchoring system

Abstract

Objectives. To evaluate the preliminary results and complications of a new, minimally invasive, transvaginal sacrospinous colpopexy for vault and uterovaginal prolapse. Methods. Twelve women, 41 to 79 years old, underwent sacrospinous fixation by palpation using the Raz Anchoring System (RAS) between October 1998 and September 1999. The vaginal vault prolapse was grade II and III in 4 and 6 patients, respectively. Two patients had grade III uterovaginal prolapse. Two patients underwent RAS alone, and 10 underwent RAS in conjunction with simultaneous related vaginal surgery. Eleven patients underwent vaginal vault and one uterovaginal fixation. RAS features two components: first, a 15-mm-long cylindrical titanium anchor and second, a disposable inserter. A penetration limiter tube allows one to penetrate the sacrospinous ligament up to the desired depth. The anchor is released into the ligament and then the vaginal apex is fixed in place. Results. The minimum and mean follow-up was 12 and 16 months, respectively. The operative time to complete the colpopexy ranged from 8 to 15 minutes. We recorded only one recurrent vaginal vault prolapse due to pull-through of the suspension sutures through the vagina. No significant perioperative complications occurred. No de novo or recurrent cystocele, rectocele, enterocele, stress urinary incontinence, urgency, or frequency was seen. Defecation was normal in all patients. Coital function was normal in 8 patients who were still sexually active. No patient experienced perineal or buttock pain. Conclusions. RAS seems to be quick, easy, safe, and effective in the suspension of vaginal apex to the sacrospinous ligament, but our preliminary results must be confirmed by controlled prospective studies with a larger number of patients and wider follow-up.