Exploration of the safe suture area of the presacral space in sacrocolpopexy by 3-dimensional (3D) models reconstructed from CT

Introduction and hypothesis The objective of this study, a digital in vivo anatomical study based on patient-specific three-dimensional (3D) models reconstructed from computed tomography (CT) scans, was to clarify the anatomy of the presacral space and suggest a safe area for complication-free graft or mesh fixation. Methods We retrospectively studied 182 CT angiography (CTA) datasets from Han Chinese women examined for gynecological diseases from January 2018–June 2020; we used Mimics 21.0 to create 176 3D models of the female presacral space. The distances of pelvic structures from the presacral vessels and ureters were standardized and measured in 3D mode. Results The distances from the median sacral artery (MSA) to the bilateral great vessels and bilateral ureters at the sacral promontory (SP) level were similar to the respective distances from the midpoint of the SP (MSP) to those four structures ( p > 0.05). At the level of the first transverse line, when the MSA was right of the midline, the MSA was 20.74 ± 3.86 mm from the medial edge of the left first anterior sacral foramen. When the MSA was left of the midline, its average distance from the medial edge of the right first anterior sacral foramen was 20.89 ± 4.92 mm. The SP was 9.71 ± 4.49 mm and 40.39 ± 6.74 mm, respectively, from the first and second sacral transverse veins along the midline. Conclusions To preserve important vasculature, we recommend a 30 × 20-mm (L × W) avascular rectangular-shaped area, 10 mm below the SP and alongside the MSA, for safe graft or mesh attachment during sacrocolpopexy.