Vaginal mesh repair SYSTEMS for pelvic organ prolapse: Anatomical study comparing transobturator/trangluteal versus single incision techniques

Introduction: The present study aim to compare the anatomic landmarks of two pelvic floor repair systems, in order to identify the potential neurovascular lesions related to different mesh fixation techniques. Methods: Abdominal and perineal dissections of 10 fresh cadavers after prolapse surgery using transobturator/transgluteal versus single incision techniques. Neuro-vascular structures of obturator region and perineum were isolated. Distances between needles and anatomical structures were measured. Results: During transobturator anterior repair, the superficial cannula passed 2.5 ± 0.6 cm medially to the obturator canal. The distance of superficial arm to the anterior obturator vessels was 2.2 ± 0.4 cm. The distance of deep cannula to the posterior obturator vessels branches was 1.3 ± 0.5 cm. In two of these cases we observed a lesion of posterior obturator vessels. During single incision repair the distance between the obturator canal and the superficial arms was 2.3 ± 0.7. The mean distances of superficial arms to the anterior and posterior obturator vessels were, respectively, 2.3 ± 0.5 cm and 3.2 ± 0.7 cm. During transgluteal posterior repair the distance between the cannula guide and the ischial spine was 1.7 ± 0.5 cm while it measured 2.3 ± 0.4 cm when single incision posterior device was placed. Conclusions: Anterior transobturator system presents an increased risk of posterior obturator vessels branches injury. During posterior transgluteal repair the distance of the ischio-anal fossa to sacrospinous ligament represents a way that could rule against the correct needle positioning with increased risk of pudendal lesions. Single incision approach offers an easier access to the sacrospinous ligament with lower risk of pudendal lesions.