Optimizing Percutaneous Sacrospinous Fixation with Suture Passing Device

Abstract

Study Objective

We demonstrate a novel surgical step to further refine the minimally invasive, percutaneous, anchor-based approach to the sacrospinous ligament suspension (SSLS).

Design

This is a video recorded case report of a novel surgical technique. The patient was discharged on postoperative day 0 with outpatient follow up planned for 2 and 6 weeks postoperatively.

Setting

This same-day surgery was performed with the patient in dorsal lithotomy positioning.

Patients or Participants

Patient consent was obtained for the recording and educational presentation of a deidentified video. The consent form is preserved within the confidential patient electronic medical record.

Interventions

The standard surgical steps for the percutaneous, anchor-based device placement were followed, with one key modification. Instead of using a free needle, we employed the suture passer device to pass the sacrospinous sutures under the vaginal epithelium for placement through the cervical stroma.

Measurements and Primary Results

Final apical suspension was measured at -7cm. At her two-week postoperative visit, the patient was feeling well, meeting all milestones, and her surgical sites were well-healing. The vaginal apex remained suspended.

Conclusion

In this video, we present a modification to the percutaneous, anchor-based approach to SSLS using the suture passing device. This technique allows for more accurate suture passage under the vaginal epithelium and ultimately through the cervical stroma as compared to the free needle. Such enhanced precision decreases tissue trauma and minimizes the risk of inadvertent intraoperative organ injury. By utilizing the suture-passing device during the percutaneous SSLS procedure, we further optimize operative efficiency while improving patient safety and surgical outcomes.