(Video Poster 19) Optimizing Percutaneous Sacrospinous Fixation with Suture Passing Device

Objectives: We demonstrate a novel surgical step to further refine the minimally invasive, percutaneous, anchor-based approach to the sacrospinous ligament suspension (SSLS).

Methods: Patient consent was obtained for the recording and educational presentation of a deidentified video. The standard surgical steps for the percutaneous, anchor-based device placement were followed, with one key modification. Instead of using a free needle, we employed the suture passer device to pass the sacrospinous sutures under the vaginal epithelium for placement through the cervical stroma.

Clinical Relevance: The social and economic impacts of pelvic organ prolapse grow exponentially as the world population continues to age. Over time, surgical techniques have evolved, trending towards minimally invasive approaches while optimizing patient outcomes. The percutaneous, anchor-based device provides a significant advancement in the SSLS technique by reducing surgical morbidity through shortened operative times, less surgical dissection, and decreased blood loss. These improvements benefit all patients and increase access for those patients once considered poor surgical candidates due to medical comorbidities. In this video, we present a modification to the standard procedure using the suture passing device. This technique allows for more accurate suture passage through the cervical stroma as compared to the free needle. Such enhanced precision decreases tissue trauma and minimizes the risk of inadvertent intraoperative organ injury. By utilizing the suture-passing device during the percutaneous SSLS procedure, we further optimize operative efficiency while improving patient safety and surgical outcomes.