A Technique for Separating Sutures During Sacrocolpopexy
Drs. K. Kenton, L. Brubaker
Loyola University School of Medicine
Maywood, Illinois

Objective:  To poster-display our method of preventing multiple sutures from getting entangled during sacrocolpopexy.
Description of technique:  After the peritoneum has been dissected from the vagina, a 4 x 7 cm piece of mesilene mesh is prepared to attach to the posterior vagina.  The mesh is attached to blue surgical towel and placed on the patient’s abdomen.  The operating surgeon places two rows of permanent suture through the posterior vagina starting at the rectal reflection and working toward the cuff.  The first assistant places both arms of each suture through the mesh.  A sponge that contains Kittner dissectors is placed on the blue towel on either side of the mesh.  The sponge has 6 near full-thickness cuts placed in it, so up to six sutures can be easily separated. (Figure 1)  When all sutures are placed through the vagina and the mesh, the two sponges containing the sutures are passed to the second assistant.  The operating surgeon and first assistant can then take one suture at a time from the sponge and tie the sutures in order.   The mesh is secured to the vagina without needing to untangle or separate the sutures.
Experience and analysis :  The technique has enabled us to place multiple sutures prior to tying without the sutures getting tangled.  It has simplified our sacrocolpopexy technique and shortened our operating time.  We have also applied this technique to keeping sutures separate during apical suspensions and paravaginal repairs.