The anatomy of the sacral promontory: How to avoid complications of the sacrocolpopexy procedure.
Am J Obstet Gynecol
; 218(4): 457.e1-457.e3, 2018 04.
Article
en En
| MEDLINE
| ID: mdl-29305252
ABSTRACT
Because of problems with vaginal meshes and the high rate of recurrences of native tissue repair, more and more surgeons treat pelvic organ prolapse with laparoscopic sacrocolpopexy. This surgery requires skilled surgeons. The first step of sacrocolpopexy is the dissection of tissues in front of the sacral promontory to reach the anterior longitudinal ligament. Some complications can occur during this dissection and the attachment of the mesh. This step is dangerous for surgeons because of the proximity of vessels, nerves, and ureters. The lack of knowledge of anatomy can lead to severe complications such as vascular, ureteral, or nerve injuries. These complications can be life-threatening. To show anatomic concerns when surgeons dissect and affix the mesh on the anterior longitudinal ligament, we have developed a video of the promontory anatomy. By reviewing anatomic articles about vessels, nerves, and ureters in this localization, we propose an educational tool to increase the anatomic knowledge to avoid severe complications. In this video, we show an alternative location for dissection and graft fixation when the surgeon believes that mesh cannot be fixed safely on the anterior surface of S1, as currently recommended.
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Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Sacro
/
Procedimientos Quirúrgicos Ginecológicos
Límite:
Female
/
Humans
Idioma:
En
Revista:
Am J Obstet Gynecol
Año:
2018
Tipo del documento:
Article