Iliococcygeus Fixation for Vaginal Vault Prolapse

Fig. 10.1

Pelvic diaphragm. The pelvic diaphragm is made up of (1) the coccygeus muscle and (2) the levator ani: the puborectalis pubococcygeus (or pubovisceral) and iliococcygeus muscles. Additional structures to note: arcus tendineus fascia pelvis, arcus tendineus levator ani, obturator internus muscle, piriformis muscle, ischial spine, obturator canal (Adapted from Figure 2.2 in Walters and Karram [8])

Fig. 10.2

Left iliococcygeus fixation. The Breitsky-Navratil retractor is used to sweep the rectum and pararectal fat medially. The retractor is held by the assistant

Fig. 10.3

Left iliococcygeus fixation. The metal suction tip exposes the iliococcygeus muscle. The Breitsky-Navratil retractor is medial

Fig. 10.4

Left iliococcygeus fixation. A single 0-PDS suture on a CT-2 needle is placed 1 cm medial and 1 cm caudad to the ischial spine into the iliococcygeus muscle using a long, straight needle driver

Fig. 10.5

Images for demonstration of anatomy, patient’s right side. (a) Stitch is on the coccygeus muscle. (b) Stich is on the SSL. Arrow indicates the iliococcygeus muscle

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