E-Posters-Bilateral Sacrospinous Ligament Flaps for Treating Apical Pelvic Organ Prolapse: A Combined Cadaver and MRI Study

Bilateral Sacrospinous Ligament Flaps for Treating Apical Pelvic Organ Prolapse: A Combined Cadaver and MRI Study - Chin H. Yong, MBCHB, FRANZCOG

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The study aimed to establish a new surgical technique for native tissue apical suspension using bilateral sacrospinous ligament (SSL) flaps. The feasibility of the procedure was evaluated through cadaver dissections and the safety of the technique was assessed using pelvic MRI images. <br /><br />In the abdominal approach, four cadavers underwent dissection, but SSL flap fixation was only feasible in two cases due to difficulties in identifying the ischial spine and restricted access in individuals with a large body habitus. One case resulted in rectal injury during dissection. In the vaginal approach, six cadavers underwent transvaginal dissection, and bilateral SSL flaps were successfully created in all cases without viscus injury. The vaginal apex or uterus appeared well supported in all cases.<br /><br />Fifty MRI images were analyzed, showing that the SSL had an average length of 51.5mm and thickness of 3.5mm. The mean distances between neurovascular structures and the ischial spine were 8.1mm for pudendal vessels and 10.4mm for inferior gluteal vessels.<br /><br />The results indicated that the transvaginal approach to bilateral SSL flap fixation for apical prolapse was feasible and safe based on the cadaver dissections and MRI analysis. The abdominal approach was less favorable due to difficulties in identifying the SSL and increased risk of viscus injury. Further studies are needed to explore the clinical application of this technique.<br /><br />The study was funded by a research scholarship from Urogynecology Society of Australasia for Dr. C Yong, and there were no disclosures from other investigators.

Keywords

surgical technique

native tissue apical suspension

bilateral sacrospinous ligament

SSL flaps

feasibility evaluation

cadaver dissections

safety assessment

pelvic MRI images

transvaginal approach

apical prolapse