Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system

Jeanditgautier, Estelle; Mayeur, Olivier; Brieu, Mathias; Lamblin, G.; Rubod, Chrystèle; Cosson, Michel

doi:10.1007/s00192-015-2917-0

Cited by 16 publications

(8 citation statements)

References 25 publications

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“…Vaginal tactile royalsocietypublishing.org/journal/rsfs Interface Focus 9: 20190014 royalsocietypublishing.org/journal/rsfs Interface Focus 9: 20190014 imaging proposes to diagnose PFDs using a vaginally inserted probe that measures applied pressure to assess tissue elasticity and pelvic floor support [162]. Magnetic resonance imaging data are forming the basis for computational modelling using finite-element analysis to understand the biomechanical properties of pelvic floor muscles and their pathologies [163][164][165].…”

Section: Future Directions For Grafts and Meshmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

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Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.

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Section: Future Directions For Grafts and Meshmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

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“…The method leads to interesting results linking medical imaging process to the definition of the pelvic organs mobility and the stress‐strain equilibrium. Understanding the impact of surgical techniques to treat the patient is essential for the development of more effective surgical prolapse repair . Numerical simulations of the organ's mobility allow to advance our knowledge on the impact of various surgical techniques and to improve surgical decision‐making on the choice of techniques, by considering the mobility of organs with this method.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Three‐dimensional physics‐based registration of pelvic system using 2D dynamic magnetic resonance imaging slices

Courtecuisse

Jiang

Mayeur

et al. 2020

Strain

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This paper introduces a method for dynamic 3D registration of female pelvic organs using 2D dynamic magnetic-resonance images (MRIs). The aim is to provide a better knowledge and understanding of pathologies such as prolapsus or abnormal mobility of tissues. 2D dynamic MRI sequences are commonly used in nowadays clinical routines in order to evaluate the dynamic of organs, but due to the limited view, subjectivity related to human perception cannot be avoided in the diagnoses. A novel method for 2D/3D registration is proposed combining 3D finite element models with a priori knowledge of boundary conditions, in order to provide a 3D extrapolation of the dynamic of the organs observed in a single 2D MRI slice. The method is applied to the four main structures of the female pelvic floor (bladder, vagina, uterus and rectum), providing a full 3D visualisation of the organs' displacements. The methodology is evaluated with two patient-specific data sets of volunteers presenting no pelvic pathology, and a sensitivity study is performed using synthetic data. The resulting simulations provide an estimation of the dynamic 3D shape of the organs facilitating diagnosis compared with 2D sequences. Moreover, the method follows a protocol compatible with current clinical constraints presenting this way potential short term medical applications.

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“…This geometric model was then imported into the geometric CAD model with software CATIA V5-6R2013, compatible with the numerical simulation software Abaqus CAE 2022 [ 25 , 26 ]]. Then, we modeled a total hysterectomy and recreated the pubocervical fascia, endopelvic fascia and ATFP by using the CAD software CATIA V5-6R2013.…”

Section: Methodsmentioning

confidence: 99%

“…But, no study has currently evaluated the mobility and stresses of the pelvic organs before and after apical prolapse repair by posterior sacrospinous ligament fixation. Moreover, these studies were not patient-specific [ 25 , 26 ]. The originality of this work comes also from the fact that we customized the model to become patient-specific.…”

Section: Introductionmentioning

confidence: 99%

Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system

Lallemant,

Shimojyo,

Mayeur

et al. 2024

PLoS ONE

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Introduction and hypothesis In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient’s pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). Methods Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix’s or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. Results Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. Conclusion According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. Trial registration ClinicalTrials.gov Identifier: NCT04551859.

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Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system

Abstract: Our model enables us to simulate and analyze an infinite number of surgical hypotheses. Even if these results are not validated at a clinical level, we can observe the importance of the association of both an anterior and a posterior mesh or the number of sutures.

Cited by 16 publications

References 25 publications

Managing female pelvic floor disorders: a medical device review and appraisal

Managing female pelvic floor disorders: a medical device review and appraisal

Three‐dimensional physics‐based registration of pelvic system using 2D dynamic magnetic resonance imaging slices

Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system

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