Partner Western OB/GYN Minneapolis, Minnesota, United States
Objectives: < ! This video describes and shows the technique of performing a transvaginal mesh augmented sacrospinous ligament hysteropexy using a free piece of soft macroporous polypropylene mesh, with a novel technique of passing and tensioning the sacrospinous ligament mesh arms.
Methods: < ! The patient has stage 3 anterior and apical compartment pelvic organ prolapse. In addition to the hysteropexy and anterior colporrhaphy, the surgery included a posterior colporrhaphy, perineorrhaphy, and mid-urethral sling that are not shown. Described is the technique of using high volume hydro-dissection of the layer between the vaginal epithelium and bladder, making a transverse incision in the prolapsed mid-vagina (avoiding a midline incision that may have a higher risk of separating and resulting in mesh exposure), dissecting paravaginally exposing the sacrospinous ligament coccygeus muscle complexes, dissecting to the cervix, placing pully stiches into the ligament muscle complexes 2 cm medial to the ischial spines, fashioning a trapezoidal piece of mesh with arms off the base of the trapezoid, using the pully stitches with a finger as a wheel around which the mesh arms are passed smoothly through the sacrospinous ligament coccygeus muscle complex, attaching the base of the trapezoid mesh to the cervix and top of the trapezoid to connective tissue near the urethral vesical junction, and finally tensioning the mesh arms precisely, providing apical and anterior compartment support.
Clinical Relevance: < ! For select patients, this hysteropexy technique provides mesh augmented apical and anterior compartment support, a technique that can also be used identically at the time of vaginal hysterectomy or post-hysterectomy prolapse. The novel way of passing the mesh arms through the ligament complex allows for easy placement and intraoperative tensioning; avoiding direct suturing to the ligament which may increase postoperative pain.
