Promedon ANCORIS POP Repair System Instructions D'utilisation page 5

j. Insert the TAS to the top side of the sacrospinous ligament 2 to 2.5 cm
medial from the ischial spine. Figure 1 shows the correct direction to apply
pressure when inserting the TAS. The surgeon should use the index finger to
touch and identify the ligament and to guide the retractable insertion guide
to its correct implant location. The TAS should be placed bilaterally, one in
each sacrospinous ligament.
k. Once the TAS have been correctly placed, two stitches are placed at the
paracervical ring or vaginal vault with the sutures coming from the TAS and
the half circle surgical eye needle provided. The depth of suturing in the
attachment points should be deep enough to avoid later tearing.
l. The incision made in the anterior vaginal wall is closed. At this point, the
vaginal apex is guided down bilaterally with the help of the index finger and
3 running knots and 2 blocking knots on each side towards the sacrospinous
ligaments, avoiding excessive tension.
m. Standard closure of the vaginal wall is completed.
n. Final antisepsis is performed. Digital rectal examination and placement of
a vaginal tampon is recommended.
Note: The plastic knot pusher and its protective tube are included in the
kit in order to facilitate the knotting procedure of the TAS if the surgeon
considers it advisable.
Posterior Approach:
The description of the technique is summarized in the following steps:
a. Patient should be in dorsal lithotomy position with legs raised and bent,
under spinal, local or general anesthesia. The administration of prophylactic
therapy with antibiotics should be considered, according to hospital
procedures.
b. Insert a size 12 or 14 Foley catheter in the urethra.
c. Make a lengthwise incision along the posterior vaginal wall, beginning 2
cm below the vaginal apex.
d. Perform a lateral blunt dissection towards the ischial spine, then identify
the ischial spine, the coccygeal muscle and the sacrospinous ligament on the
right side. The same procedure is performed on the left side.
e. Identify the right ischial spine as a point of reference and determine the
position, size and thickness of the sacrospinous ligament.
f. To prime the ANCORIS POP Repair System, the tip of the RIG needs to
be moved out by pressing the trigger on the handle down and shoving it
forward.
g. Once the tip of the RIG is fully moved out, attach the anchor to the tip
by firmly sliding it on to the tip. The TAS is fully connected when the metal
tip of the RIG is clearly visible on the top of the TAS. Please note during
the whole maneuver that the spikes of the TAS are sharp and may damage
gloves.
h. Optionally shove the protective tube over the RIG and make sure that the
sutures of the TAS are running inside the protective tube.
i. Carefully guide the TAS with the RIG downwards to the sacrospinous
ligament by guidance of the index finger.
j. Insert the TAS to the top side of the sacrospinous ligament 2 to 2.5 cm
medial from the ischial spine. Figure 1 shows the correct direction to apply
pressure when inserting the TAS. The surgeon should use the index finger to
touch and identify the ligament and to guide the retractable insertion guide
to its correct implant location. The TAS should be placed bilaterally, one in
each sacrospinous ligament.
Figure 1
Figure 1
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