Anchorsure® System
The Anchorsure® System (Neomedic International) is a PEEK anchor-based fixation device for attaching sutures to pelvic-floor ligaments, including the sacrospinous ligament in apical prolapse repair. Unlike a suture-capturing instrument such as Capio, it deploys an anchor carrying a polypropylene suture into the ligament.[1][7] It is a fixation device, not a mesh; an anterior approach is one described application.[1][7]
Design
- Straight, narrow delivery handle for transvaginal ligament access.
- PEEK (polyetheretherketone) anchor with USP-0 monofilament polypropylene suture. The A-SURE kit contains a preloaded handle, extra anchor and surgical needle; A-SURE02 contains two anchors.
- Native-tissue fixation is possible without a mesh. Follow the particular product instructions: the available March 2016 English IFU describes the system as sterile, single-use, and not to be reprocessed or resterilized; request an updated IFU from the manufacturer before use.[7][8]
Rationale — Anchor vs Suture Capture
Traditional suture-based SSLF requires tight suture knots around or through the ligament, which may:
- Compress or compromise neurovascular structures (pudendal nerve, inferior gluteal vessels)
- Contribute to gluteal or buttock pain, the characteristic SSLF complication
- Depend on ligament tissue quality to hold the knot long-term
The anchor embeds fixation within the ligament rather than encircling it, a proposed mechanical rationale for less pain. In a small randomized comparison (24 anchor, 23 suture capture), gluteal or posterior-thigh pain at one week did not differ significantly.[2] The IFU still warns of possible vessel or nerve puncture, pain, infection, fistula and extrusion.[7]
Reconstructive / Urogyn Uses
- Vaginal vault prolapse after hysterectomy (apical suspension)
- Uterovaginal prolapse with sacrospinous fixation (Amreich–Richter technique)
- Post-hysterectomy vault prolapse repair
- Anterior approach to SSLF is a described access route; comparative mechanical or clinical superiority is not established[1]
For placement, the available IFU directs the surgeon to position and press the handle against the ligament, advance the delivery shaft completely, withdraw the handle, secure the proximal suture and attach its tip to the curved needle to suture the intended tissue. Confirm the current model's instructions and contraindications, including anticoagulation, pregnancy or planned pregnancy and connective-tissue autoimmune disease.[7]
Efficacy
| Endpoint | Result | Source |
|---|---|---|
| Sexual function at 3 mo (FSFI total score) | 19.15 → 21.84 in a two-center uncontrolled cohort (115 enrolled, 104 completed follow-up) | Ahmadian 2026[3] |
| Objective / subjective cure rates | Lo's 676-patient mixed tacker cohort included only 19 Anchorsure-alone procedures | Lo 2026[4] |
Complications
| Complication | Rate / Finding | Source |
|---|---|---|
| Day-1 postoperative pain | Slightly higher with ABD (3.40 vs 1.60 SCD, p = 0.013); mean highest pain score similar overall | Evangelopoulos 2024 pilot case-control (n = 40)[1] |
| Gluteal / posterior-thigh pain at 1 wk, 6 wk | No significant difference vs Capio | Plair 2022 RCT[2] |
| Opioid use postoperatively | Similar to Capio | Plair 2022 RCT[2] |
| Prolapse symptom scores | Similar to Capio | Plair 2022 RCT[2] |
| Tacker dislodgement | In a retrospective cohort of 676 anchor-based SSLF procedures (657 with transvaginal mesh kits, 19 with Anchorsure alone), 27 patients were grouped as having a dislodged tacker (reported as 2.2% of cases), with 2 bladder injuries and 4 operator injuries (glove tears, finger cuts) in that group | Lo 2026[4] |
| Nerve injury / reoperation | Amiri's meta-analysis (125 studies, 10,216 cases) reports 3.8% nerve injury overall across methods (highest with Capio) and 1.2% reoperation overall, with higher reoperation rates listed for the Shutt Suture Punch, Laurus and Anchorsure. The meta-analysis pooled single-arm data. | Amiri 2024 SR + meta-analysis[5] |
In the Lo cohort, patients with tacker dislodgement had a higher BMI and more hypertension, and the secure-tacker group had less blood loss; dislodgement exposed both the patient (bladder injury) and the operator (glove tears, finger cuts).[4]
Anchorsure vs Capio — Head-to-Head Comparison
| Feature | Anchorsure (Anchor-Based) | Capio (Suture-Capturing) |
|---|---|---|
| Mechanism | Deploys anchor into SSL substance | Passes suture through SSL |
| Gluteal / posterior-thigh pain | No significant difference vs Capio[2] | No significant difference vs Anchorsure[2] |
| Day-1 postop pain | Slightly higher (3.40 vs 1.60)[1] | Slightly lower[1] |
| Nerve injury | Not among the devices with the highest pooled nerve-injury rate[5] | Highest device-level nerve-injury rate in a pooled meta-analysis (3.8% overall across methods)[5] |
| Reoperation | Listed among the devices with higher pooled reoperation rates (overall 1.2%); no head-to-head trial[5] | Not among the devices listed with higher reoperation[5] |
| Anterior approach to SSL | Described clinical use[1] | Feasibility depends on exposure and operator technique; no comparative mechanical advantage established |
| Device-specific concern | Tacker dislodgement in mixed-device cohort; Anchorsure rate unresolved[4] | Neurovascular proximity applies to all SSLF instrumentation[5] |
The small randomized trial found no detected short-term pain difference.[2]
Context Within POP Surgery
SSLF is a vaginal apical-support option that can be performed as native-tissue repair. Zhang's meta-analysis included 4,120 cases (5 randomized trials, 8 retrospective and 2 prospective studies). In the abdominal sacrocolpopexy subgroup, SSLF had lower study-defined success (88.3% vs 91.5%; OR 0.52) and more dyspareunia (14.4% vs 4.7%); the success analysis included 3,890 patients across 12 studies and the dyspareunia analysis 499 across 7 studies before restriction to that subgroup. Success definitions and follow-up varied among studies. SSLF had less hemorrhage, wound infection and gastrointestinal morbidity.[6] Other fixation or capture options include Saffron, Capio, Endostitch and i-Stitch.
Regulatory / Commercial Status
The available IFU has US prescription-sale caution language; FDA cleared Anchorsure under 510(k) K120831 on October 12, 2012, for attaching suture to pelvic-floor ligaments.[7][9] Check the jurisdiction, device model and current regulatory listing before procurement or use.
See also: Capio Suture Capturing Device, Saffron Fixation System, i-Stitch, Endostitch, Miya Hook, Deschamps Ligature Carrier.
References
1. Evangelopoulos N, Delacroix C, Abdirahman S, de Tayrac R. "Safety of an anchor-based device for sacrospinous ligament fixation: a pilot case-control study." Eur J Obstet Gynecol Reprod Biol. 2024;299:105–109. doi:10.1016/j.ejogrb.2024.06.012
2. Plair A, Smith W, Hines K, et al. "Gluteal and posterior thigh pain from a suture compared with an anchor-based device in patients undergoing sacrospinous ligament fixation: a randomized controlled trial." Obstet Gynecol. 2022;139(1):97–106. doi:10.1097/AOG.0000000000004629
3. Ahmadian N, Rastkar E, Amiri E, Bastani P, Sattarpour R. "Sexual function after Anchorsure repair of sacrospinous ligament suspension in patients with pelvic organ prolapse: a prospective multicenter study." Sci Rep. 2026. doi:10.1038/s41598-026-52719-w
4. Lo TS, Rellora LE, Yu CC, Ro AL, Yang CH. "Operator and patient injuries from tacker dislodgement during sacrospinous ligament fixation: a retrospective study." BJOG. 2026;133(4):716–724 (online 2025). doi:10.1111/1471-0528.70089
5. Amiri E, Bastani P, Mallah F, Mostafaei H, Salehi-Pourmehr H. "Comparison of the complications rate of different suture-passing techniques at the time of sacrospinous ligament fixation: a systematic review and meta-analysis." Arch Gynecol Obstet. 2024;310(6):2791–2809. doi:10.1007/s00404-024-07788-5
6. Zhang W, Cheon WC, Zhang L, et al. "Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis." Int Urogynecol J. 2022;33(1):3–13. doi:10.1007/s00192-021-04823-w
7. DIMA/Neomedic. Anchorsure instructions for use. English revision March 2016; obtain current IFU for the supplied model.
8. Neomedic. Anchorsure product description. Accessed 2026-09-21.
9. US Food and Drug Administration. Anchorsure 510(k) substantial equivalence determination K120831. October 12, 2012.