title: Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth.
abstract: OBJECTIVE
  To determine the variation in vaginal axis and posterior cul-de-sac depth when the lowest suture used to attach the sacrocolpopexy mesh to the anterior longitudinal ligament is anchored at different levels.
  
  
  METHODS
  At five lumbosacral mesh attachment sites, the anterior vaginal wall axis angle was measured relative to a line between the lowest border of the pubic symphysis and fourth sacral (S4) foramen in 9 unembalmed cadavers. The vertical distance from S4 to the posterior mesh was measured as a surrogate of cul-de-sac depth.
  
  
  RESULTS
  From a mesh fixation point at the lower border of S2 to a point at the lower border of L5, there was a 3-fold increase in both vaginal axis angle (13.04 ± 3.19 vs 42.88 ± 4.16 cm) and distance from S4 to the posterior mesh (2.50 ± 0.61 vs 7.38 ± 1.30 cm) between these points.
  
  
  CONCLUSIONS
  During sacrocolpopexy, progressively cephalad sacral attachment increases vaginal axis angle and cul-de-sac depth.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Balgobin
authors.forename: Meadow M
authors.initials: MM
authors.lastname: Good
authors.forename: Shena J
authors.initials: SJ
authors.lastname: Dillon
authors.forename: Marlene M
authors.initials: MM
authors.lastname: Corton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004312:Douglas' Pouch / Q000033:anatomy & histology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D017846:Longitudinal Ligaments / Q000033:anatomy & histology; D008161:Lumbosacral Region / Q000033:anatomy & histology; D008875:Middle Aged; D011631:Pubic Symphysis / Q000033:anatomy & histology; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000033:anatomy & histology*