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Objectives

Technical challenges with mesh fixation during robotic-assisted laparoscopic sacrocolpopexy include difficulty finding and visualizing the sacral promontory (most superior portion of the S1). This may lead to mesh placement above in the L5-S1 and L4-L5 vertebral discs and subsequent catastrophic complications including discitis and osteomyelitis. The objective of this study was to further characterize the relevant relationships of the bony anatomy relevant to the sacral promontory to use as a guide for safe mesh placement.

Materials and Methods

The anatomical relationships of the lumbar and sacral spine were reviewed in 25 female patients’ computed tomography (CT) studies for benign indications. Anatomy quantified included 1) angle of descent between the anterior surfaces of the L4 and L5 vertebra 2) angle of descent between the anterior surfaces of the L5 and S1 vertebra 3) L4-L5 disc height and …