Sacrospinous ligament fixation using long needle holder: a simple technique in low resource countries

ABSTRACT
Objective. The objective of this study was the evaluation of sacrospinous ligament fixation using long needle holder for uterine prolapse.
Materials and Methods. This was a prospective study conducted over 10 patients including patients with uterine prolapse who were negative for hepatitis B, C virus and human immunodeficiency virus and excluding previous failure of ligament fixation. Right sacrospinous ligament fixation was performed using long needle holder through long posterior vaginal wall incision to suture a ligature to the back of the cervix or the vaginal vault and the ligament using Vicryl one suture, on a half-circle needle of 36 mm length. Primary outcome was evaluating the failure rate by recurrence at one year after surgery. Secondary outcome was assessing complications.
Results. The mean follow-up period was 1 year. No major intra- and post-operative complications occurred. Duration of surgery regarding ligament dissection and fixation was 30-45 min.
Conclusions. Transvaginal sacrospinous cervico and colpopexy can be performed with uterovaginal prolapse using long needle holder. It is more tedious and time consuming but can be used in low resource countries. Dissection of the whole length of the posterior vagina wall is needed for easy entry of the large needle with more than one attempt may be needed at the same setting for trans-fixing the ligament. High incidence of surgeon’s finger injury can occur but can be avoided with experience. This technique may be an alternative in low resource countries, when a Miya hook and Capio devices are not available.