You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112079 ANTERIOR SACROSPINOUS LIGAMENT FIXATION ASSOCIATED WITH PARAVAGINAL REPAIR USING THE PINNACLETM DEVICE. AN ANATOMICAL STUDY Idir Ouzaid, Mélanie Cayrac, Vincent Letouzey, Pierre Costa, Renaud de Tayrac, and Vincent Delmas Idir OuzaidIdir Ouzaid Paris, France More articles by this author , Mélanie CayracMélanie Cayrac Nîmes, France More articles by this author , Vincent LetouzeyVincent Letouzey Nîmes, France More articles by this author , Pierre CostaPierre Costa Nîmes, France More articles by this author , Renaud de TayracRenaud de Tayrac Nîmes, France More articles by this author , and Vincent DelmasVincent Delmas Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2374AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To study reproducibility and anatomical risks after anterior sacrospinous ligament fixation associated with paravaginal repair using the PinnacleTM device (Boston ScientificTM). METHODS A simplified bilateral anterior SSL fixation associated with a paravaginal fixation through the ATFP was performed on five fresh cadavers using the Pinnacle deviceTM and the CapioTM needle driver (Boston ScientificTM). Cadavers were installed in gynecologic position. Fixations were performed after midline anterior vaginal wall incision and dissection of both paravesical fossae. Then we performed a postero-lateral pelvic side wall dissection by open pelvic surgery and retropubic space entrance. RESULTS Eight SSL and ten ATFP were available for analysis. SSL fixations were optimal (through the SSL) in 4/8 cases, too superficial (through the coccygeus muscle or the fascia) in 3/8 cases and too high (close to the pudendal nerve) in one case. Mean distance between SSL fixation and ischial spine was 18.6 mm (range 10 to 30). Mean distance between SSL fixation and pudendal nerve was 6.5 mm (range 0 to 15). ATFP fixations were optimal (through the ATFP) in 5/10 cases, good (through the arcus tendineus levator ani or through the obturator internal muscle) in 4/10 cases and too superficial (through the fascia) in one case. Mean distance between ATFP fixation and ischial spine was 27.3 mm (range 12 to 45). Mean distance between ATFP fixation and obturator nerve was 33.8 mm (range 15 to 55). In one case (10%), the middle arm was in contact to the ureter and the traction on that arm showed a ureteral kinking. CONCLUSIONS Anterior sacrospinous ligament fixation associated with paravaginal repair using the PinnacleTM device was not reproducible every time in this cadaver study. Furthermore, that study highlighted some specific pudendal nerve and ureteral risks. Cadaver dissections are different of real and live surgery but these results confirm the need for a specific training before to start anterior SSL fixations. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e832 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Idir Ouzaid Paris, France More articles by this author Mélanie Cayrac Nîmes, France More articles by this author Vincent Letouzey Nîmes, France More articles by this author Pierre Costa Nîmes, France More articles by this author Renaud de Tayrac Nîmes, France More articles by this author Vincent Delmas Paris, France More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...