Perineal approach to vascular anatomy during transobturator cystocele repair

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 116; no. 5; pp. 708 - 712
• Main Authors: Touboul, C, Nizard, J, Fauconnier, A, Bader, G
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2009; Blackwell; Wiley Subscription Services, Inc
• Subjects: Abdominal Muscles - anatomy & histology; Abdominal Muscles - pathology; Adult; Anatomy; Biological and medical sciences; Bladder; Blood Loss, Surgical; Blood vessels; Cadaver; Cystocele - pathology; Cystocele - surgery; cystocele repair; Dissection; Female; Gynecology. Andrology. Obstetrics; haemorrhagic risk; Health risk assessment; Humans; Iliac Artery - injuries; Injuries; Medical sciences; Nephrology. Urinary tract diseases; Obstetrics; obturator area; Perineum - anatomy & histology; Perineum - pathology; Risk Assessment; Surgical Mesh; Surgical techniques; Suture Techniques; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urogenital system; Urinary system disease; Cystocele; Gynecology; Blood vessel; Bladder disease; Urinary tract disease; Anatomy; Repair; Obstetrics
• ISSN: 1470-0328; 1471-0528; 1471-0528
• DOI: 10.1111/j.1471-0528.2008.01983.x

Objective  To evaluate the risk of vascular injury during transobturator approach of cystocele repair. Design  Dissection of the obturator area by perineal approach was performed after placement of mesh needles used for cystocele mesh repair. Setting  Surgery school of Paris. Population or sample  Twenty obturator regions in ten fresh female cadavers. Methods  Transperineal dissection of the obturator area was conducted in ten fresh female anatomic subjects after inserting anterior Prolift® needles. Main outcome measures  The vascular anatomy of the obturator region was mapped. Distances between needles and vascular structures of the obturator area were measured three times and averaged for each side. Results  The anterior cannula‐equipped needle perforated the gracilis and the adductor brevis muscles. The mean (SD) distance to the anterior obturator vessels was 21.2 (1.6) mm on the right side and 20.4 (1.5) mm on the left. The posterior needle perforated the adductor magnus. Its distance to the posterior division of the obturator vessels was 1.8 (1.0) mm on the right side and 1.1 (0.9) mm on the left. Conclusions  During mesh cystocele repair by transobturator approach, the posterior obturator vessels division seems at risk of injury during the posterior needle insertion.