Bone anchors boost safety of ab sacrocolpopexy: series of 11 cases.(Gynecology)

Abdominal sacrocolpopexy can be much safer if bone anchors are used instead of traditional sutures, according to Dr. Luis Sanz, professor and vice chairman of the department of obstetrics and gynecology at Georgetown University, Washington.

"The surgery has been described before, but this technique is the innovation," he said in an interview.

Traditional abdominal sacrocolpopexy for the treatment of total vaginal vault prolapse requires the placement of sutures into the longitudinal ligament of the vertebra, Dr. Sanz explained. This is done to anchor a Prolene mesh graft (Gynecare Gynemesh, made by Ethicon Inc.) between the end of the vaginal cuff and the ligament.

Incorrect placement of the curved needle could damage the presacral vessels, inferior vena cava and abdominal aorta, which run through close to the ligament, posing a risk of hemorrhage and requiring blood transfusion, he said.

But with the use of a press-in bone anchor system (the Vesica Press-In Suture Anchor System made by Boston Scientific) this risk is greatly reduced.

"When the sutures are placed using a needle, it's hard to control the tip of the needle, and it may lacerate some of the vessels next to it. But with the press-in anchor, you can go lateral to the middle sacral veins and press in at only one point. We are pushing into the bone, it goes in, and that's it--not pushing and pulling with a needle," said Dr. Sanz, who said he does not have a financial interest in the anchor system.

Dr. Sanz recently described a series of 11 cases in which he used this technique (J. Reprod. Med. 48[7]:496-500, 2003).