Operator and Patient Injuries From Tacker Dislodgement During Sacrospinous Ligament Fixation: A Retrospective Study.

Abstract

<h4>Objective</h4>To identify the factors contributing to tacker dislodgement and associated complications during sacrospinous ligament fixation (SSF) procedures.<h4>Design</h4>Retrospective study.<h4>Setting</h4>Tertiary medical center.<h4>Population</h4>Six hundred and seventy-six patients with stage ≥ 3 pelvic organ prolapse (POP) who underwent SSF with anchor-based devices (tackers) between April 2018 and November 2023.<h4>Methods</h4>Of these, 657 underwent SSF with transvaginal mesh (Surelift: 463; Calistar-S: 194), and 19 underwent SSF with Anchorsure alone. Patients were grouped into secure (n = 649) and dislodged tacker (n = 27) groups. Standardised institutional protocols, included pre-operative assessments, validated Chinese questionnaires at baseline and follow-up at 6 and 12 months postoperatively.<h4>Main outcome measures</h4>Determine the occurrence of a tacker dislodge during application and the injury caused to the patient and the operator.<h4>Results</h4>Tacker dislodgement occurred in 2.2% of the cases. The dislodged group had a significantly higher BMI (p < 0.001) and prevalence of hypertension (p = 0.004). Complications in this group included two bladder injuries and four operator injuries, including glove tears and finger cuts (p < 0.001). The secure group demonstrated significantly less blood loss than the non-secure group (p < 0.001). Objective and subjective cure rates were high and comparable between the groups: 95.5% and 94.4% for the secure group and 90% for the dislodged group. The quality of life and sexual function outcomes were similarly favourable.<h4>Conclusion</h4>SSF using a tacker-based device was safe and effective. Recognising the risks associated with tacker dislodgement can enhance preparedness and minimise complications for both patients and operators.