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  • Küçük Resim
    Öğe
    Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures
    (Galenos Yayincilik, 2020) Pulatoğlu, Çiğdem; Dogan, Ozan; Medisoglu, Mahmut Sabri; Yassa, Murat; Kaya, Aski Ellibes; Selcuk, Ilker; Bayik, Rahime Nida
    Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9 +/- 0.76 cm on the left and 6.5 +/- 1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8 +/- 0.52 cm on the left and 3.6 +/- 0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04 +/- 0.23 cm, to the left corona mortis it was 2.15 +/- 0.48 cm, and to the left obturator canal it was 3.12 +/- 0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25 +/- 0.43 cm, to the right corona mortis it was 2.37 +/- 0.63 cm, and to the right obturator canal it was 3.57 +/- 0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.
  • Küçük Resim
    Öğe
    Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study
    (Springer Science and Business Media Deutschland GmbH, 2021) Pulatoğlu, Çiğdem; Yassa, Murat; Turan, G.; Turkyilmaz, Deniz; Dogan, Ozan
    Introduction and hypothesis: Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. Methods: Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case–control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. Results: The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). Conclusion: The vaginal axis was found to be near-normal in patients who underwent LLMS.