TRANSVAGINAL SACROSPINOUS COLPOPEXY - ANATOMIC LANDMARKS TO BE AWARE OF TO MINIMIZE COMPLICATIONS

Transvaginal sacrospinous colpopexy is currently used to repair varyin g degrees of vaginal vault prolapse. It involves placing a stitch from the vaginal cuff to the sacrospinous ligament approximately 2 cm medi al to the ischial spine to correct the defect. This may be associated with pudendal artery and nerve (pudendal complex) along with sciatic n erve injury if the procedure is not carefully performed. This study wa s designed to emphasize the anatomic landmarks that make the sacrospin ous ligament a potentially dangerous zone that surgeons must be aware of to minimize complications. Twenty-four female cadavers were obtaine d from the Louisiana State University Medical School anatomy laborator y, They were carefully dissected to expose the anatomic structures of interest. The following measurements were then obtained: the distance from the ischial spine to the medial border of the sacrum, the medial and lateral aspects of the pudendal complex, and the sciatic nerve. Th e obstetric conjugate of the pelves was also obtained. The pudendal co mplex acid sciatic nerve were found to be 0.90 to 3.30 cm medial to th e ischial spine. After the six smallest and largest pelves were compar ed, it was noted that the larger the obstetric conjugate the longer th e sacrospinous ligament and vice versa. Also, the distance from the is chial spine to the sciatic nerve correlated with the size of the obste tric conjugate, The pudendal complex and sciatic nerve travel undernea th the lateral third of the sacrospinous ligament. Therefore we recomm end that the placement of the stitch be made medial to that portion of the ligament. More importantly, the stitch must be placed as superfic ial as possible and never across the entire thickness of the sacrospin ous ligament. This should decrease the rate of complications associate d with this type of colpopexy.