Modified Sacrospinous Colpopexy with Standard Needle and Needle-Holder: Video Presentation

Among the different operations for treatment and prevention of vaginal vault prolapse, sacrospinous colpopexy is the most preferred one. Many devices are used to perform this operation. Unfortunately these devices are not easily available in developing countries. This paper shows an improvisation wherein, to make the operation easier using standard needle and needle-holder, under direct visualisation, a stage 3 POP-Q vault prolapse, patient was operated. Needle was held longitudinally at its middle so that the long axis of the needle and needle-holder were in the same line. (Traditionally, needle is held transversely, hence long axis of needle and needle- holder remains perpendicular to each other). Swag end of the needle touched the needle-holder. This positioning created a smaller diameter at needle-holder tip than the diameter created by the traditional holding. Bite on sacrospinous ligament was from above downwards and forwards which coincided the normal curvature of the needle. Inferiorly, needle came out easily and retrieval was also easy. The sutures were then brought out through the apex of the vault which was tied after posterior vaginal mucosa closure, High-up vaginal vault was seen at the end. Holding the needle longitudinally eases the sacrospinous operation in the narrow operative field.