title: Anterior sacrospinous ligament fixation associated with paravaginal repair using the Pinnacle device: an anatomical study.
abstract: OBJECTIVE
  The objective of this paper is to study the reproducibility and anatomical risks of anterior sacrospinous ligament (SSL) fixation associated with paravaginal repair using the Pinnacle device (Boston Scientific).
  
  
  METHODS
  Simplified bilateral anterior SSL fixation associated with paravaginal fixation through the arcus tendineus fascia pelvis (ATFP) was performed on five fresh cadavers using the Pinnacle device. Cadaver dissection was then performed by open pelvic surgery.
  
  
  RESULTS
  Eight SSL and ten ATFP were available for analysis. SSL fixations were optimal in four cases, too superficial in three cases, and too high in one case. Mean distance between SSL fixation and ischial spine was 18.6 mm (range 10 to 30 mm). Mean distance between SSL fixation and pudendal nerve was 6.5 mm (range 0 to 15 mm). ATFP fixations were optimal in five cases, good in four cases, and too superficial in one case. In one case (10%), the middle arm of the prosthesis was in contact with the ureter and traction on that arm resulted in ureteral kinking.
  
  
  CONCLUSIONS
  Anterior SSL fixation associated with paravaginal repair using the Pinnacle™ device was not reproducible every time in this cadaver study. These results confirm the need for specific training before starting anterior SSL fixations.
authors: Obstetrics and Gynaecology Department, Caremeau University Hospital, Place du Pr Robert Debré, 30029 Nîmes cédex 9, France. melaniecayrac@hotmail.fr
authors: Mélanie
authors: M
authors: Cayrac
authors: Vincent
authors: V
authors: Letouzey
authors: Idir
authors: I
authors: Ouzaid
authors: Pierre
authors: P
authors: Costa
authors: Vincent
authors: V
authors: Delmas
authors: Renaud
authors: R
authors: de Tayrac
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*