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Critical Anatomy for Robotic Sacrocolpopexy

A Long-term Follow-up Study

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

Female Pelvic Medicine & Reconstructive Surgery: April 11, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000730
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Objective This study aimed to assess anatomy relative to sacral sutures 20 to 24 months after robotic sacrocolpopexy.

Methods This was an institutional review board–approved prospective anatomy study of women undergoing robotic sacrocolpopexy. After placement of suture into the anterior longitudinal ligament, a small vascular clip was secured on the base of the suture. Subjects were imaged at 6 weeks and between 20 and 24 months after surgery. Measurements were calculated by the primary investigator and radiologist coinvestigator.

Results Of the 11 subjects enrolled in the initial 6-week postoperative study, 5 (45%) completed the long-term follow-up. Regarding the vascular anatomy, no significant changes were documented. Similarly, the major urologic structure, the right ureter, was stable at 16 mm from the clip. A significant change was noted, however, in the distance from the apex of the vagina to the sacral suture. At 6 weeks postoperatively, the mean (SD) distance from the vaginal apex to the clip was 69.3 (14) mm; this increased to 85.2 (11.3) mm at the long-term follow-up (P = 0.004).

Conclusions Reassuringly, the position of the clip remained stable, which is reflected in the constancy of the measurements to the vascular landmarks. Nevertheless, alteration in the distance to the vaginal apex suggests elongation of the mesh or vaginal tissue with time. Although the increase in length was greater than 1.5 cm, it may bear clinical relevance in certain patients. This information may help guide surgeons regarding appropriate mesh tensioning during this critical step of the procedure.

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.

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

This study received an educational grant from the TriHealth Medical Education Research Fund for the cost of imaging.

The authors have declared that there are no conflicts of interest.

Paper Presentation: Selected for poster presentation at the 37th Annual American Urogynecologic Society National Scientific Meeting in Denver, CO.

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