Modélisation biomécanique des mobilités des organes pelviens : vers une médecine personnalisée

Cosson, Michel; Rubod, Chrystèle; Vallet, A.; Witz, Jean‐François; Brieu, Mathias

doi:10.1016/s0001-4079(19)31924-7

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Our study is the first of its kind. Generic model of POP physiopathology or POP repair already exist in the literature [ 16 , 17 , 26 ]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, we hypothesize that numerical simulation using the Finite Element (FE) method could help reduce recurrences by analyzing the mobility of the pelvic system following different kinds of SSF and understanding the phenomena involved in this complex equilibrium [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…In order to improve the knowledge of this complex system, a biomechanical model of the female pelvic system allowing to simulate and study the mobilities of the pelvic organs from pelvic MRI (Magnetic Resonance Imaging) has been developed [16,17]. The results obtained on a healthy patient come from the team's previous studies, which linked the patient's actual mobility [19,20] to the digital twin [21,22].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lallemant,

Shimojyo,

Mayeur

et al. 2024

PLoS ONE

Self Cite

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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

et al. 2016

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Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth

Maran

Cassagnes

Delmas³

et al. 2017

Surg Radiol Anat

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Mechanical pressures responsible for the tensioning of the constituent muscles of the urogenital sinus were qualitatively identified during the second stage of labor. MRI-based vector 3-D models allow the quantitative assessment of levator ani muscle stretching during labor, but 2-D MRI is not sufficient for describing perineal expansion. Vector 3-D models from larger scale studies have the potential to aid in the calibration of a realistic simulation based on the consideration of the reaction of each muscular element. These models offer perspectives to enhance our knowledge regarding perineal expansion during childbirth as a risk factor for postpartum perineal defects.

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Modélisation biomécanique des mobilités des organes pelviens : vers une médecine personnalisée

Cited by 3 publications

References 10 publications

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

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

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

Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth

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