Perineal approach to vascular anatomy during transobturator cystocele repair.

OBJECTIVE To evaluate the risk of vascular injury during transobturator approach of cystocele repair. DESIGN Dissection of the obturator area by perineal approach was performed after placement of mesh needles used for cystocele mesh repair. SETTING Surgery school of Paris. POPULATION OR SAMPLE Twenty obturator regions in ten fresh female cadavers. METHODS Transperineal dissection of the obturator area was conducted in ten fresh female anatomic subjects after inserting anterior Prolift needles. MAIN OUTCOME MEASURES The vascular anatomy of the obturator region was mapped. Distances between needles and vascular structures of the obturator area were measured three times and averaged for each side. RESULTS The anterior cannula-equipped needle perforated the gracilis and the adductor brevis muscles. The mean (SD) distance to the anterior obturator vessels was 21.2 (1.6) mm on the right side and 20.4 (1.5) mm on the left. The posterior needle perforated the adductor magnus. Its distance to the posterior division of the obturator vessels was 1.8 (1.0) mm on the right side and 1.1 (0.9) mm on the left. CONCLUSIONS During mesh cystocele repair by transobturator approach, the posterior obturator vessels division seems at risk of injury during the posterior needle insertion.