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Van der Weyden et al propose a different site of mesh fixation during laparoscopic sacrocolpopexy. Our comments to this suggestion are the following.


By changing the side of fixation down to the level of S3, the axis of the vagina will change postoperatively compared with fixation at the level of the promontory. Whether this alternative fixation level leads to the same anatomical and functional results, especially in the anterior compartment, should be demonstrated in prospective studies.


Nerve damage during laparoscopic sacrocolpopexy can occur at various locations during laparoscopic sacrocolpopexy. One location is obviously the presacral space during fixation of the mesh. The other location is during the dissection of the peritoneum on the right side of the sigmoid colon for later peritonealization of the mesh. At this site the crossing fibers coming from the superior hypogastric plexus and going to the pelvic side wall are at risk for damage.


In our video (Sarlos et al, 2015), we demonstrate how this nervous tissue can be saved to avoid postoperative morbidity after laparoscopic sacrocolpopexy. In our opinion, it is not so much the technique of mesh fixation (anchors or suturing) that is important to prevent nerve damage but, rather, the anatomical knowledge of the autonomic nervous system of the pelvis and the nerve-sparing surgical technique.

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May 5, 2017 | Posted by in GYNECOLOGY | Comments Off on Reply

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