Sunil Balgobin1, Meadow M Good, Shena J Dillon, Marlene M Corton. 1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Abstract
OBJECTIVE: To determine the variation in vaginal axis and posterior cul-de-sac depth when the lowest suture used to attach the sacrocolpopexy mesh to the anterior longitudinal ligament is anchored at different levels. STUDY DESIGN: At five lumbosacral mesh attachment sites, the anterior vaginal wall axis angle was measured relative to a line between the lowest border of the pubic symphysis and fourth sacral (S4) foramen in 9 unembalmed cadavers. The vertical distance from S4 to the posterior mesh was measured as a surrogate of cul-de-sac depth. RESULTS: From a mesh fixation point at the lower border of S2 to a point at the lower border of L5, there was a 3-fold increase in both vaginal axis angle (13.04 ± 3.19 vs 42.88 ± 4.16 cm) and distance from S4 to the posterior mesh (2.50 ± 0.61 vs 7.38 ± 1.30 cm) between these points. CONCLUSION: During sacrocolpopexy, progressively cephalad sacral attachment increases vaginal axis angle and cul-de-sac depth.
OBJECTIVE: To determine the variation in vaginal axis and posterior cul-de-sac depth when the lowest suture used to attach the sacrocolpopexy mesh to the anterior longitudinal ligament is anchored at different levels. STUDY DESIGN: At five lumbosacral mesh attachment sites, the anterior vaginal wall axis angle was measured relative to a line between the lowest border of the pubic symphysis and fourth sacral (S4) foramen in 9 unembalmed cadavers. The vertical distance from S4 to the posterior mesh was measured as a surrogate of cul-de-sac depth. RESULTS: From a mesh fixation point at the lower border of S2 to a point at the lower border of L5, there was a 3-fold increase in both vaginal axis angle (13.04 ± 3.19 vs 42.88 ± 4.16 cm) and distance from S4 to the posterior mesh (2.50 ± 0.61 vs 7.38 ± 1.30 cm) between these points. CONCLUSION: During sacrocolpopexy, progressively cephalad sacral attachment increases vaginal axis angle and cul-de-sac depth.
Authors: Robin M F van der Weiden; Elena Rociu; Guido H H Mannaerts; Marcel H A van Hooff; Mark E Vierhout; Mariella I J Withagen Journal: Int Urogynecol J Date: 2013-10-22 Impact factor: 2.894
Authors: Marjorie L Pilkinton; Gregory C Levine; Laura Bennett; Harvey A Winkler; Dara F Shalom; Peter S Finamore Journal: Int Urogynecol J Date: 2017-10-04 Impact factor: 2.894
Authors: Shaniel T Bowen; Pamela A Moalli; Steven D Abramowitch; Mark E Lockhart; Alison C Weidner; Cecile A Ferrando; Charles W Nager; Holly E Richter; Charles R Rardin; Yuko M Komesu; Heidi S Harvie; Donna Mazloomdoost; Amaanti Sridhar; Marie G Gantz Journal: Am J Obstet Gynecol Date: 2021-06-01 Impact factor: 10.693