The Pull-Out Strength of Laparoscopic Sacrohysteropexy and Vaginal Sacrospinous Ligament Fixation in a Cadaver Model

The objective was to determine the biomechanical strength of laparoscopic sacrohysteropexy (LSH) and sacrospinous ligament fixation (SSLF) by evaluating their pull-out forces.

This study was conducted during a cadaver workshop in Taiwan, which allowed the participants to perform multiple vaginal and abdominal procedures for pelvic organ prolapse. The study focused on biochemical strength assessment of LSH and SSLF. Six fresh cadavers underwent LSH or SSLF using various anchoring techniques. LSH procedures used sutures and tackers to fixate to the sacral promontory or uterus, whereas SSLF was performed using the tackers only. A digital crane scale was used to measure pull-out strength for each procedure. Results recorded the maximum load at failure.

The SSLF procedure provided stronger apical support than LSH, with pull-out forces ranging from 25.3 to 52.5 N compared with LSH promontory fixation, which ranged from 12.6 to 13.7 N. Tackers used in SSLF showed consistent load bearing across all samples (44-47 N), whereas LSH grip strength varied with stitch numbers and anatomical positioning on the sacral promontory, with an average of 12.6 N. Vaginal load values are relatively consistent, with an average of 42.6 N across all cadavers. The instructor's initial attempt consistently demonstrated the highest strength, emphasizing the impact of the technique.

The SSLF procedure provided superior apical support to LSH, suggesting that it might be preferable for managing POP. Variations in ligament condition affected outcomes, but SSLF provided more reliable support. A need for further research in live subjects is needed to verify the optimal anchoring approach in POP repair.