Depth and Location of Sacral Suture Placement During Cadaveric Simulation of Open Sacrocolpopexy

Objectives: To evaluate the location and depth of placement of sacral sutures in a cadaveric sacrocolpopexy model.

Materials and methods: Following a 1-hour instructional session, trainees performed an open sacrocolpopexy on unembalmed cadavers under guidance by a Female Pelvic Medicine & Reconstructive Surgery board-certified surgeon. At completion of the session, the presacral tissues were dissected and the location and depth of each sacral suture was identified.

Results: A total of 19 sutures were placed by 9 trainees into 8 cadavers. The majority of sutures (14/19, 74%) were placed between L5 and S1. Three sutures (16%) were placed at L5 and 2 (11%) were placed at the S1 vertebral body. The mean depth of the anterior longitudinal ligament (ALL) was 1.4 mm. When assessing depth of suture placement, 13 of 19 (68%) were placed into the ALL without penetrating the disc space. Two sutures (11%) were placed in the tissues superficial to the ALL and 4 (22%) were placed deep to the ALL into the periosteum or disc.

Conclusion: This study of cadaveric simulation of open sacrocolpopexy finds that location of sacral suture placement is most commonly at the level of the L5-S1 disc space and that placement of sutures into the underlying disc occurs about 1 in 5 times.