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Sacrocolpopexy Tacker

Helical titanium tackers are one way to secure sacrocolpopexy mesh to the anterior longitudinal ligament at the sacral promontory; sutures are the other. Devices that attach mesh to the vagina or cervix are a separate question, and their bench strength or time savings do not transfer to sacral fixation. Choose the device, site and depth with the local vascular and spinal anatomy in view.[3][12]

For laparoscopic sacrocolpopexy technique and postoperative imaging, see references 1 and 2.[1][2]

Tacker Family​

DeviceConstructionResorbable?Attachment studied here
ProTack (Medtronic/Covidien)Helical titaniumNon-absorbableStudied for sacral PVDF-tape fixation and separately for cervical PVDF-tape attachment; these are different experiments[3][12]
AbsorbaTack (Medtronic/Covidien)Absorbable helical fastenerAbsorbableThe cited 15 ± 8 N experiment is cervical tape attachment, not sacral fixation[3]
Barbed/absorbable mesh anchorSingle-fire anchorDevice-specificBerger studied vaginal mesh attachment, not the sacral anchor[6]
SutureMaterial and technique varyMaterial-dependentComparators in distinct sacral and cervical experiments[3][12]

Keep the sites separate. Sebastian et al. tested PVDF-tape attachment to 28 fresh porcine cervices: sutures 64 ± 15 N (n=10), ProTack 41 ± 10 N (n=10), AbsorbaTack 15 ± 8 N (n=8), and fixation-device failure was the most common failure mode with AbsorbaTack (mesh failure was most common with sutures and ProTack). These figures do not measure sacral-promontory fixation.[3] Jansen et al. separately tested PVDF tape on porcine sacral anterior longitudinal ligament: two sutures 65 ± 12 N, three titanium tacks in a row 25 ± 10 N, and three in a triangle 38 ± 12 N (n=10 each). Mesh failure was the most common failure mode (9 of 10 trials in each of the three groups). Bench models do not measure clinical recurrence or pain.[12]

Reconstructive-Urology and Urogyn Uses​

Sacral-promontory fixation in laparoscopic / robotic sacrocolpopexy​

  • Yoshizawa 2021, a retrospective 77-patient comparison, studied sutures plus tackers (n=41) against sutures alone (n=36), not tacker-only fixation. The combination group had shorter mean operative time (104.9 ± 27.0 versus 147.5 ± 33.7 minutes); one-year anatomical success was 100% versus 94.4% (p=0.2153). The latter does not demonstrate tacker-only equivalence or a long-term durability advantage.[4]
  • Vieillefosse 2015, a case-control series (35 tacker versus 65 suture patients), reported higher postoperative low-back-pain intensity in the tacker group (median VAS 4 versus 0, p=0.01); the difference in de novo pain incidence (50% versus 25%, p=0.11) and operative time (240 versus 210 minutes, p=0.18) were not statistically significant. An association does not establish that tack penetration caused pain.[5]

Vaginal-mesh attachment (anchor variants)​

  • Berger 2020 RCT (robotic sacrocolpopexy) compared anchors with sutures for vaginal mesh attachment; that step was faster with anchors (12.2 versus 21.2 minutes), whereas total sacrocolpopexy time did not differ (107.6 versus 109.8 minutes). This is not a trial of sacral tackers.[6]

Interpreting the evidence​

  • The separate porcine sacral test favors two sutures over three titanium tacks in load to failure for one PVDF tape construct, but not every mesh/device pairing. Retrospective clinical comparisons are heterogeneous and cannot establish a universal fixation hierarchy.[4][5][12]
  • Moroni 2018 reviewed the technique described in 22 randomized trials of sacrocolpopexy. Sacral fixation materials (absorbable and non-absorbable sutures) and vaginal dissection varied widely, and most trials gave no full standardized description. The review did not compare tackers with sutures.[7]

Tacker vs Suture — The Decision​

FeatureHelical tacker (ProTack)Permanent suture
Sacral bench strengthThree ProTack tacks: 25 ± 10 N (row) or 38 ± 12 N (triangle)Two sutures: 65 ± 12 N, same porcine PVDF-tape study[12]
Cervical bench strengthProTack 41 ± 10 N; AbsorbaTack 15 ± 8 N64 ± 15 N, different cervical experiment[3]
Operative timeShorter in one combination cohort; not in the tacker-only case-control seriesComparator differed by cohort[4][5]
One-year anatomy100% in a combination cohort; not tacker-only equivalence94.4% in suture-only comparison, p=0.2153[4]
Lumbar pain intensityHigher median VAS in one case-control seriesLower median; causal mechanism not established[5]
QoLWorse in the Vieillefosse comparisonObservational result, not universal prediction[5]
Spondylodiscitis riskPossible (case reports)Possible (case reports)

The clinical evidence is bench work and retrospective series; a randomized promontory comparison was not identified. Weigh site, material, surgeon technique and patient risk rather than extrapolating from bench or single-center data.[4][5][7]

Safety Profile​

Spondylodiscitis / lumbosacral osteomyelitis​

A rare but devastating complication of any sacral fixation (suture or tack):

  • Antosh 2024 reported three institutional cases and reviewed 30 additional published patients. Back pain, elevated ESR/CRP and variable timing were reported; in the reviewed cases, the majority required mesh excision and extended IV antibiotics. This complication has been described after different routes and both sutures and tackers, not proved specific to a device.[8]
  • Propst 2014 review. Pyogenic spondylodiscitis after sacral colpopexy and rectopexy; same management principle.[9]

Vascular injury at the promontory​

  • Identify the promontory, anterior longitudinal ligament, nearby middle sacral vessels or presacral veins, ureter, iliac vessels and disc level before fixation. Avoid assuming a spine-screw study defines a validated tacker-safe zone or device-specific penetration depth.[10]

Periosteal lumbar pain​

  • Vieillefosse observed more intense low-back pain in a tacker group, but did not demonstrate a periosteal mechanism.[5]

Other​

  • Mesh exposure and fastener displacement depend on the operative site and device instructions. The sources above do not give a comparative rate.

Emerging Alternatives​

  • Cyanoacrylate glue for vaginal or anterior mesh attachment. Not promontory tacking: a 54-patient RCT reported shorter anterior fixation time (4.6 versus 25.4 minutes) but no significant difference in total operative time or 24-month anatomical outcomes. It cannot be used to infer sacral fixation efficacy.[11]

Technique Considerations​

  • Identify the promontory and expose the anterior longitudinal ligament while respecting the vessels, ureter and disc. Check the device's current IFU for indication and fixation depth; the studies here do not set either.
  • Secure mesh without excess tension, inspect attachment, and cover the mesh with peritoneum according to the operative plan. The precise number or pattern of tacks varies; three-tack row/triangle configurations were bench-test constructs, not universal clinical instructions.[12]
  • If combining sutures with tackers, follow the actual operative method and material instructions; Yoshizawa compared combination fixation with sutures alone and does not define a standard suture-plus-tack pattern.[4]

Limitations​

  • Cost, pain and operative time vary by device and setting, and a porcine pull-test is not a clinical selection rule. The absorbable-fastener experiment was at the cervix and says nothing about absorbable devices at the promontory.[3]
  • Long-term recurrence and device-specific safety have not been compared prospectively. Follow the product's indications and training requirements.

See also: Capio Device, Anchorsure, Miya Hook, SAFFRON Fixation System, Ti-Knot Fastener, Midurethral Sling Trocars.

References​

1. Kavallaris A, Zygouris D. "Laparoscopic sacrocolpopexy comparing polypropylene mesh with polyvinylidene fluoride mesh for pelvic organ prolapse: technique description and long-term outcomes." Neurourol Urodyn. 2020;39(8):2264–71. doi:10.1002/nau.24480

2. Zacharakis D, Grigoriadis T, Bourgioti C, et al. "Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients?" Neurourol Urodyn. 2018;37(1):316–21. doi:10.1002/nau.23294

3. Sebastian L, Alina J, Fabinshy T, et al. "AbsorbaTack™ vs ProTack™ vs sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model." Arch Gynecol Obstet. 2023;307(3):863–71. doi:10.1007/s00404-022-06827-3

4. Yoshizawa T, Mochida J, Yamaguchi K, et al. "Laparoscopic sacrocolpopexy for pelvic organ prolapse: comparison of standard versus tacker combination method." Int J Urol. 2021;28(12):1227–32. doi:10.1111/iju.14676

5. Vieillefosse S, Thubert T, Dache A, Hermieu JF, Deffieux X. "Satisfaction, quality of life and lumbar pain following laparoscopic sacrocolpopexy: suture vs tackers." Eur J Obstet Gynecol Reprod Biol. 2015;187:51–6. doi:10.1016/j.ejogrb.2015.02.014

6. Berger AA, Tan-Kim J, Menefee SA. "Anchor vs suture for the attachment of vaginal mesh in a robotic-assisted sacrocolpopexy: a randomized clinical trial." Am J Obstet Gynecol. 2020;223(2):258.e1–258.e8. doi:10.1016/j.ajog.2020.05.018

7. Moroni RM, Juliato CRT, Cosson M, Giraudet G, Brito LGO. "Does sacrocolpopexy present heterogeneity in its surgical technique? A systematic review." Neurourol Urodyn. 2018;37(8):2335–45. doi:10.1002/nau.23764

8. Antosh DD. "Lumbosacral discitis and osteomyelitis after sacrocolpopexy: a case series and review of management." Int Urogynecol J. 2024;35(12):2243–54. doi:10.1007/s00192-024-05897-y

9. Propst K, Tunitsky-Bitton E, Schimpf MO, Ridgeway B. "Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature." Int Urogynecol J. 2014;25(1):21–31. doi:10.1007/s00192-013-2138-3

10. Mirkovic S, Abitbol JJ, Steinman J, et al. "Anatomic consideration for sacral screw placement." Spine. 1991;16(6 Suppl):S289–94.

11. Lamblin G, Moufawad G, Becque C, et al. "Laparoscopic sacrocolpopexy with mesh fixation: a randomized trial comparing synthetic cyanoacrylate glue to sutures." World J Urol. 2025;43(1):598. doi:10.1007/s00345-025-05885-x

12. Jansen AK, Ludwig S, Malter W, et al. "Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model." Arch Gynecol Obstet. 2022;305:631–39. doi:10.1007/s00404-021-06343-w