A novel technique for sacrospinous ligament fixation. Use a finger to identify the sacrospinous ligament as the preferred site of attachment. Position finger guide device at anchor position in the medial third and lower half of the sacrospinous ligament. Account for 12 mm distance from the center of finger guide to lateral working channel. The patented finger guide helps protect the rectum by keeping the rectum medial as the working channel remains lateral. Before removing the safety latch and driving the anchor, push the inserter through the working channel until it passes through the ligament. Once in position, release the safety latch from delivery system while maintaining firm pressure against the ligament. Press the anchor driving button using index finger to assure proper anchor deployment. Upon deployment, withdraw the inserter and finger guide. Make sure the anchor is deployed behind the ligament, allowing the wings to open and ensure the necessary resistance to pull out. This particular patient may benefit from additional colporaphy for her grade II systoseal. After deployment, check the anchor position and pull-out force gently. Target fixation point is in the sacrospinous ligament. Repeat the anchoring procedure on the contralateral side. Position the anchor within the axis of the vagina. Note, significant pressure is applied to overcome the natural resistance of the fibrous ligament tissue. Check tension of the sutures for pull-out force. Pass the free ends of the anchor-mounted sutures behind the vaginal wall and fix to the uterine cervix. Attach each of the free ends of the suture to a free needle in order to secure them to the cervix. Pass sutures behind the vaginal wall through a small incision at the posterior or anterior aspect of the cervix. Repeat on contralateral side. Surgeons recommend using a 1-1⁄2-inch curved mayo needle. Complete the same steps on the contralateral side. Use a single incision for a substantial purchase of cervical tissue. Repeat on contralateral side. Tie the sutures through a 1-centimeter longitudinal shallow incision at the vaginal posterior or anterior fornix. Finish using multiple knots, seven or eight, carefully assuring no air knots. In this case, pre-placed closing sutures were used when vaginal incision was made. Close the incision using an absorbable suture. Suture ties should be covered with vaginal skin. Aim for C-point of minus 6 or minus 7, being cautious not to over-tension. Pain Management This surgeon doesn't prescribe opioids for this patient population. Minimal pain medication. Passive voiding trial with bladder scan. Post-op POP-Q score is available online as a helpful addition. Conduct a post-op rectal exam. A stool softener should be used 10 to 14 days post-op. This surgeon routinely conducts cystoscopy at the end of each procedure. A novel technique for sacrospinous ligament fixation.

sacrospinous ligament fixation

finger guide device

working channel

anchor deployment

post-operative care