Prospective study of single incision transvaginal mesh with apical fixation to treatment of anterior vaginal wall prolapses

The procedure is performed with the patient in lithotomy position. After doing a hydrodissection, anterior vaginal wall incision is made from midurethra towards the uterine cervix and the pubocervical fascia is carefully dissected. Blunt dissection is performed towards the ischial spine, and coccigeous muscle, identifying the ischial spines and the sacrospinous ligaments. Then the retractable insertion guide is primed with the tissue anchoring system and is introduced into the sacrospinous ligament 1.5 cm medial from the ischial spine. The tissue anchoring system is released and the insertion guide is gently retracted. The same maneuvers are repeated on the other side. For insertion of the implant, first, the retractable insertion guide is connected to the multipoint fixation arm and is introduced towards the internal obturator muscle, one centimeter above the vaginal fornix, guided by surgeon’s index finger. When the centering mark of the implant is at the midurethra at a properly position, the trigger at the handle is retracted to release in place the fixation arm. The multipoint fixation arms design provides strong and stable primary fixation. Cystoscopy is not mandatory. Then, the polypropylene stitches are attached to the arms of the implant bilaterally. Stitches are placed at the posterior body of the implant and fixed at the remanents of cardinal ligaments or pericervical ring in order to avoid high cystocele reccurence. Finally, the vaginal incision is closed in the usual manner. This procedure is performed about 1 hour