Abstract
Background: Laparoscopic sacrocolpopexy (LSC) is an effective and minimally invasive surgical approach for pelvic organ prolapse (POP), offering high anatomical success and a low complication rate. However, needle placement on the anterior sacral promontory requires careful technique due to the proximity of major vessels. Preoperative identification of vascular anomalies may reduce intraoperative risk.
Methods: We retrospectively analyzed 257 patients scheduled for LSC between October 2018 and October 2024. Abdominal ultrasonography (US) was performed within one month preoperatively to evaluate the vascular anatomy anterior to the sacral promontory. Vascular anomalies were defined by the presence of midline venous structures or convergence of iliac veins within 10 mm of the promontory. Intraoperative findings were compared to US results.
Results: Of 256 evaluable cases, US identified vascular anomalies in 25 (9.8%), while intraoperative findings confirmed anomalies in 14 (5.5%). Eleven cases (4.3%) showed concordance between US and surgical findings. US demonstrated a sensitivity of 78.6%, specificity of 94.2%, positive predictive value of 44.0%, and negative predictive value of 98.7%. Surgical modifications, including altered suture paths or procedural changes, were required in 14 cases with no related complications.
Conclusion: Preoperative assessment of anterior sacral promontory vessels using abdominal ultrasonography is a safe, specific, and cost-effective method. It can aid in surgical planning for LSC and may reduce the risk of vascular injury, particularly in patients where CT or MRI imaging is not feasible or desirable.
