The vaginal minimally invasive sacrospinous fixation under visual guidance: A pilot study

Sacrospinous fixation is the standard procedure for apical pelvic organ prolapse repair via the vaginal route. However, there may be a significant risk of per- and post-operative neurovascular damage due to the proximity of neurovascular structures, especially since the technique is performed by palpation without visual control. After developing a new innovative and minimally invasive technique that had been successfully tested on an anatomical model using a 1.9 mm fiber optic (NanoNeedle™, Arthrex, Germany) coupled with a specific suture capture device (I-Stitch™, AMI, Austria), we conducted a pilot clinical study.

Anterior and/or posterior sacrospinous fixation via the vaginal route was performed in 15 patients with apical prolapse. The objectives of the study were to demonstrate the feasibility of sacrospinous fixation under visual control and to evaluate the medium-term efficacy of the surgical technique at 12 months.

Identification of the sciatic spine and sacrospinous ligament, as well as feasibility of sacrospinous fixation were always possible. No perioperative nor postoperative complications were observed. No postoperative pain was reported. Complete correction of the prolapse was observed at 12 months in 87 % of cases. Patient satisfaction was higher at 1, 6, and 12 months according to the various quality of life questionnaires used (PGI, SF-12, PFIQ-7, PFDI-20, PISQ-12).

This innovative minimally invasive new technology appears to be particularly relevant and could offer advantages in terms of safety and improved suture placement on the sacrospinous ligament under visual control.