Native tissue sacrospinous hysteropexy from an anterior approach
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IUJ VIDEO
Native tissue sacrospinous hysteropexy from an anterior approach Andre Plair 1
&
Catherine Matthews 1
Received: 16 August 2020 / Accepted: 28 October 2020 # The International Urogynecological Association 2020
Abstract Aim of the video The goal of urogynecologic surgeons is to pair patients with the most appropriate and effective surgery. Sacrospinous hysteropexy has become an increasingly utilized surgical option for uterovaginal prolapse repair. The primary aim of this video is to highlight the role that sacrospinous hysteropexy can have in prolapse repair and to demonstrate an anterior approach for this procedure. Methods We performed a literature review to provide general information on the efficacy, risks, and comparative benefits of sacrospinous hysteropexy. Our video demonstrates the key steps in performing a sacrospinous hysteropexy procedure from an anterior approach including method of dissection, suture fixation to the sacrospinous ligament, and cervical suspension. Results Sacrospinous hysteropexy has generally been found to be an effective option for uterovaginal prolapse repair in properly selected patients. The demonstrated approach integrates sacrospinous ligament fixation with an anterior colporrhaphy. Conclusions Data and experience to date on sacrospinous hysteropexy are largely based on a posterior approach for access to the sacrospinous ligament. This surgical video demonstrates an anterior approach to sacrospinous hysteropexy that is not well characterized in the literature. Keywords Native tissue repair . Pelvic organ prolapse . Sacrospinous hysteropexy . Uterine-preservation surgery . Uterine prolapse
Introduction Pelvic organ prolapse is a condition that affects millions of women throughout the world. Surgical repair is the only definitive treatment for pelvic organ prolapse. The goal of urogynecologic surgeons is to pair patients with the most appropriate and effective surgery. Sacrospinous hysteropexy has become an increasingly utilized surgical option for uterovaginal prolapse repair [1]. The traditional approach to sacrospinous fixation has been through the posterior compartment, probably because it affords more space for exposure and direct suturing. The ability to utilize an anterior approach is enabled by the use of selfretrieving suture and anchor-based devices that require a smaller dissection to the sacrospinous ligament. The anterior * Andre Plair [email protected]
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approach is principally efficacious when a concomitant anterior repair is needed. There are notably less knowledge and experience with an anterior approach to native tissue sacrospinous hysteropexy in the urogynecologic community although transvaginal mesh-augmented repairs were often approached this way. There is conflicting evidence on the comparative efficacy of posterior sacrospinous hysteropexy compared to alternative surgical treatments for uterovaginal prolapse [1, 2]. Increased knowledge and experience with the anterior approach may afford opportunities for comparative studies. This vi
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