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Critical Anatomy Relative to the Sacral Suture

A Postoperative Imaging Study After Robotic Sacrocolpopexy

Crisp, Catrina C. MD, MSc*; Herfel, Charles V. MD; Pauls, Rachel N. MD*; Westermann, Lauren B. DO*; Kleeman, Steven D. MD*

Female Pelvic Medicine & Reconstructive Surgery: January/February 2016 - Volume 22 - Issue 1 - p 33–36
doi: 10.1097/SPV.0000000000000230
Original Articles
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Objective This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging.

Methods A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging.

Results Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.

The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.

The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%.

Conclusions We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.

Critical sacral anatomy (vascular and urologic structures) relevant to robotic sacrocolpopexy is found 10–18mm from the sacral suture, highlighting the need for adequate exposure, careful dissection, and surgeon expertise.

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, TriHealth, Good Samaritan and Bethesda North Hospitals; and †Department of Radiology, TriHealth, Good Samaritan Hospital, Cincinnati, OH.

Reprints: Catrina C. Crisp, MD, MSc, TriHealth, Good Samaritan Hospital, 3219 Clifton Ave, Medical Office Bldg Suite 100, Cincinnati, OH 45220. E-mail: Catrina_Crisp@trihealth.com.

This study was supported by an educational grant from the TriHealth Medical Education Research Fund.

The authors have declared they have no conflicts of interest.

This article was selected for full oral presentation at the 41st Annual SGS Scientific Meeting in Orlando, Fla, on March 22–25, 2015.

This article received the President's Award for Excellence in Gynecologic Research at the 41st Annual SGS Scientific Meeting in Orlando, FL, on March 22–25, 2015.

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