A new technique for sacrospinous ligament fixation: endoscopic sacrospinous ligament fixation (Peker technique).

Objectives: The aim of this study is to introduce a new technique, endoscopic sacrospinous ligament fixation (e-SSLF), and to present its success rate and advantages.

Material and methods: The hospital records of women who underwent e-SSLF and simultaneous vaginal hysterectomy due to stage 4 pelvic organ prolapse (POP) were evaluated. Unlike the classical SSLF technique, in e-SSLF the sacrospinous ligament (SSL) was exposed with two retractors, then visualized with a 5 mm diagnostic hysteroscope. The SSLF was performed endoscopically with Deschamps ligature needles. In the 24th postoperative hour, a contrast-enhanced pelvic computerized tomography (CT) was performed, and images were taken to confirm that the suture was passed to the correct location (2 cm medial to the sacrospinous process). Patient demographic and clinical data, surgery duration,total operation time, pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) levels, and complications were evaluated.

Results: Based on the evaluated medical records, 26 patients underwent e-SSLF. Postoperative CT images showed that the suture had passed to the correct place in all cases. There were no intraoperative complications, and only 2 patients experienced transient leg pain in the postoperative period. The median surgery duration was 101 seconds (25th percentile 96 seconds, 75th percentile 110 seconds). The median total operation time was 62 minutes (25th percentile 52 minute, 75th percentile 78 minute). Upon POP-Q staging at the 6-month postoperative follow-up, 24 patients (92.3%) were found to be in stage 0 and 2 (7.7%) were found to be in stage 1 POP.

Conclusions: e-SSLF is a new surgical technique that is reliable and highly effective, showing fewer complications and good postoperative results due to the imaging, it provides. Imaging in SSLF will make significant contributions to gynaecology assistant training and reduce the learning curve of SSLF.