Perineal approach to vascular anatomy during transobturator cystocele repair.
OBJECTIVE
To evaluate the risk of vascular injury during transobturator approach of cystocele repair.


METHODS
Dissection of the obturator area by perineal approach was performed after placement of mesh needles used for cystocele mesh repair.


METHODS
Surgery school of Paris.


METHODS
Twenty obturator regions in ten fresh female cadavers.


METHODS
Transperineal dissection of the obturator area was conducted in ten fresh female anatomic subjects after inserting anterior Prolift needles.


METHODS
The vascular anatomy of the obturator region was mapped. Distances between needles and vascular structures of the obturator area were measured three times and averaged for each side.


RESULTS
The anterior cannula-equipped needle perforated the gracilis and the adductor brevis muscles. The mean (SD) distance to the anterior obturator vessels was 21.2 (1.6) mm on the right side and 20.4 (1.5) mm on the left. The posterior needle perforated the adductor magnus. Its distance to the posterior division of the obturator vessels was 1.8 (1.0) mm on the right side and 1.1 (0.9) mm on the left.


CONCLUSIONS
During mesh cystocele repair by transobturator approach, the posterior obturator vessels division seems at risk of injury during the posterior needle insertion.
Touboul
C
C
Versailles-Saint Quentin University, Poissy Hospital, Department of Gynecologic Surgery, Poissy, France.
Nizard
J
J
Fauconnier
A
A
Bader
G
G
D000009:Abdominal Muscles / Q000033:anatomy & histology* / Q000473:pathology; D000328:Adult; D016063:Blood Loss, Surgical; D002102:Cadaver; D052858:Cystocele / Q000473:pathology / Q000601:surgery*; D004210:Dissection; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D010502:Perineum / Q000033:anatomy & histology* / Q000473:pathology; D018570:Risk Assessment; D013526:Surgical Mesh; D013536:Suture Techniques