An anatomical comparison of two minimally invasive pelvic reconstructive surgeries using fresh female cadavers.

BACKGROUND: During the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the Prolift(TM) and a modified pelvic reconstructive surgery with mesh.

METHODS: Twelve fresh cadavers were allocated randomly to either the Prolift(TM) or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries.

RESULTS: The mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter ((0.60 ± 0.36) cm and (0.78 ± 0.10) cm) when compared with the distances to the anterior branch of obturator arteries ((1.53 ± 0.46) cm and (1.86 ± 0.51) cm) for the reconstruction of the anterior compartment in both surgeries (all P < 0.05). The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the Prolift(TM) technique ((0.88 ± 0.10) cm) and ((1.59 ± 0.36) cm)) were much shorter than that in the modified pelvic reconstructive surgery ((2.95 ± 0.09) cm) and ((3.40 ± 0.36) cm)) for the reconstruction of the middle and posterior compartments (all P < 0.05).

CONCLUSIONS: Compared with the Prolift(TM) technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries. The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.