Suturing methods in prolapse surgery: a biomechanical analysis
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ORIGINAL ARTICLE
Suturing methods in prolapse surgery: a biomechanical analysis J. Hachenberg 1
&
A. Sauerwald 2 & H. Brunke 5 & S. Ludwig 3 & M. Scaal 6 & A. Prescher 4 & C. Eichler 2,3,7
Received: 10 June 2020 / Accepted: 10 November 2020 # The Author(s) 2020
Abstract Introduction Pelvic organ prolapse is a common problem in urogynecological surgery. Abdominal and laparoscopic sacrocolpopexy is currently considered to be the gold standard of treatment. The main problem remains the anatomical point of fixation as well as how sutures are placed. We evaluated the biomechanical difference between an in-line ligament suture versus an orthogonal ligament suture and a single suture versus a continuous suture at the anterior longitudinal ligament in an invitro, sacrocolpopexy model. Methods Biomechanical in-vitro testing was performed on human, non-embalmed, female cadaver pelvises. An Instron test frame (tensinometer) was used for load/ displacement analysis. The average patient age was 75 years. Ligament preparation yielded 15 ligaments available for testing. Recorded parameters were the ultimate load, failure displacement, and stiffness. Results This in-vitro analysis of different suturing methods showed the difference between an orthogonal and an in-line approach to be the ultimate load. Orthogonal sutures displayed an ultimate load of 80 N while in-line suturing yielded only 57 N (p < 0.05). For the anterior longitudinal ligament, this study demonstrated that continuous suture is significantly superior to a single suture regarding failure displacement (p < 0.05). Conclusion We established baseline biomechanical parameters for the sacrospinous ligament and anterior longitudinal ligament. An orthogonal suture is superior to an in-line suture in an in-vitro model. A continuous suture is superior to a single suture at the anterior longitudinal ligament. Clinical trials might be able to evaluate whether any clinical significance can be established from these findings. Keywords Pelvic organ prolapse . Uro-gynecological surgery . Biomechanical testing . Suturing technique . Laparoscopy
J. Hachenberg, A. Sauerwald, A. Prescher and C. Eichler contributed equally to this work. Statements The data shown was shown and discussed at the 214th session NWGGG and ICS 2019 Gothenburg Scientific Programme. This is the full publication. Summary The fixation of sacrocolpopexy is controversial. For the sacrospinous ligament, an orthogonal suture is superior. For the anterior longitudinal ligament, a continuous suture is superior. * J. Hachenberg [email protected] 1
Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
2
Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
3
Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
4
Department of Anatomy, RWTH Aachen University, Aachen, Germany
5
Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany
6
Department of Anatomy II, Univ
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