title: Characterization of the median sacral artery course at the sacral promontory using contrast-enhanced computed tomography.
abstract: OBJECTIVE
  Laparoscopic sacral colpopexy (SC) is increasingly utilized in the surgical management of apical prolapse. It involves attachment of a synthetic mesh to the sacral promontory and to the prolapsed vaginal walls. The median sacral artery (MSA) runs close to the site of mesh attachment and is therefore prone to intraoperative injury, which may lead to profound hemorrhaging. The aim of this study was to determine the location of the MSA at the level of the sacral promontory with regard to adjacent visible anatomical landmarks. Surgeons may use this information to reduce the risk for presacral bleeding.
  
  
  METHODS
  Sixty consecutive contrast-enhanced pelvic computed tomography scans were revised, and the location of the MSA at the level of the sacral promontory was determined in relation to the ureters, iliac arteries, sacral midline, and aortic bifurcation.
  
  
  RESULTS
  The MSA runs 0.2 ± 3.9 mm left to the midline of the sacral promontory and 48.0 ± 15.4 mm caudal to the aortic bifurcation. The ureters, internal and external iliac arteries on the right were significantly closer to the MSA than on the left (30.0 ± 7.1 vs 35.2 ± 8.8 mm, p = 0.001; 21.5 ± 6.8 vs 30.3 ± 8.4 mm, p < 0.0001; 32.8 ± 10.2 vs 41.9 ± 14.5 mm, p = 0.005 respectively).
  
  
  CONCLUSIONS
  The MSA, which runs left to the midline of the sacral promontory, and its location can be determined intraoperatively in relation to adjacent visible anatomical structures. The iliac vessels and ureter on the right are significantly closer to the MSA than those on the left. This information may help surgeons performing SC to avoid MSA injury, thus reducing operative morbidity.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Technion University, Rappaport Faculty of Medicine, Haifa, Israel. arielzilberlicht@gmail.com.|Department of Obstetrics and Gynecology, Carmel Medical Center, Technion Medical Faculty, 7 Michal Street, Haifa, Israel, 31048. arielzilberlicht@gmail.com.
authors.forename: Ariel
authors.initials: A
authors.lastname: Zilberlicht
authors.affiliation: Department of Radiology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Molnar
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Hanni
authors.initials: H
authors.lastname: Pal-Ohana
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Haya
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Auslender
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Abramov
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003127:Colposcopy / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D007472:Iohexol / Q000008:administration & dosage; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D012447:Sacrum / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D013526:Surgical Mesh; D014513:Ureter / Q000098:blood supply / Q000000981:diagnostic imaging; D014596:Uterine Prolapse / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Computed tomography; Laparoscopy; Median sacral artery; Pelvic organ prolapse; Sacral colpopexy