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Cadaveric Nerve and Artery Proximity to Sacrospinous Ligament Fixation Sutures Placed by a Suture-Capturing Device

Katrikh, Aaron Z. MS; Ettarh, Rajuno MD, PhD; Kahn, Margie A. MD

doi: 10.1097/AOG.0000000000002324
Contents: Original Research

OBJECTIVE: To simulate sacrospinous ligament fixation on cadaveric specimens, describe the surrounding retroperitoneal anatomy, and estimate the risk to nerves and arteries for the purposes of optimizing safe suture placement.

METHODS: Sacrospinous ligament fixation was performed on eight fresh-tissue female cadavers using a Capio ligature capture device. Distances from placed sutures to the following structures were measured: ischial spine; fourth sacral root; pudendal nerve; the nerve to coccygeus muscle; the nerve to levator ani muscle; inferior gluteal artery; and internal pudendal artery. Periligamentous anatomy was examined in an additional 17 embalmed cadaver dissections.

RESULTS: Sacrospinous ligament length was not seen to differ significantly between sides. The fourth sacral spinal nerve was seen most commonly associated with the medial third of the ligament, whereas the pudendal nerve and the nerves to coccygeus and levator ani muscles were associated with the lateral third. The inferior gluteal artery was seen leaving the greater sciatic foramen a median 15.8 mm (range 1.8–48.0, CI 14.9–22.3) above the ligament, whereas the internal pudendal artery exited just above the ischial spine. The two sets of sutures were placed 20.5 mm (range 9.2–34.4, CI 19.7–24.7) and 24.8 mm (range 12.4–46.2, CI 24.0–30.0) medial to the ischial spine, respectively. No structures were directly damaged by placed sutures. The nerves to coccygeus and levator ani were closest and arteries farthest from the placed sutures.

CONCLUSION: The middle segment of the sacrospinous ligament has the lowest incidence of nerves and arteries associated with it. This study confirms that the nerves supplying the pelvic floor muscles are at a higher risk from entrapment than the pudendal nerve.

After sacrospinous fixation in cadavers, the middle segment of the ligament is seen to have the lowest incidence of nerves and arteries associated with it.

Departments of Structural and Cellular Biology, Obstetrics and Gynecology, and Urology, Tulane University School of Medicine, New Orleans, Louisiana; and the Department of Medical Education, California University of Science and Medicine, Colton, California.

Corresponding author: Aaron Z. Katrikh, MS, Department of Structural and Cellular Biology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112; email: akatrikh@tulane.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the American Urogynecologic Society Pelvic Floor Disorders Week 2016, September 27–October 1, 2016, Denver, Colorado.

The authors thank the generous support of the Department of Structural and Cellular Biology for materials and equipment during this study and Dr. Stephen Jeffery for invaluable mentorship and contribution to the conception of the work.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.