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Sacrocolpopexy Tacker

Helical or barbed mesh-fixation device used to anchor the cranial end of the sacrocolpopexy mesh to the sacral promontory during laparoscopic or robotic sacrocolpopexy — the technical alternative to intracorporeal suturing at the most demanding step of the operation. The tacker shaves operative time at the cost of measurably higher postoperative lumbar pain, and biomechanical testing shows that sutures > non-absorbable tacks > absorbable tacks in fixation strength.[1][2][3]

Tacker Family​

DeviceConstructionResorbable?Typical useBiomechanical max load (porcine)
ProTack (Medtronic/Covidien)5 mm helical titaniumNon-absorbableSacral-promontory mesh fixation; 3–5 tacks typical41 ± 10 N
AbsorbaTack (Medtronic/Covidien)Glycolide / lactide copolymer helical tackAbsorbableSacral or apical mesh fixation when permanent material is undesired15 ± 8 N (failure mode: tack pulls out)
Barbed / absorbable mesh anchorsSingle-fire barbed anchorAbsorbableVaginal-mesh attachment (not sacral); faster than suturingNot directly comparable
Suture (reference)Polyester / polypropyleneNon-absorbableSacral promontory and vaginal attachment64 ± 15 N

Sebastian 2023 porcine cervical-fixation data anchor the strength hierarchy and show the dominant failure mode for AbsorbaTack is the device itself (pull-out), while non-absorbable tacks and sutures fail at the mesh rather than the fixation point.[3]

Reconstructive-Urology and Urogyn Uses​

Sacral-promontory fixation in laparoscopic / robotic sacrocolpopexy​

  • 3–5 helical titanium tacks placed through the anterior longitudinal ligament at the S1 promontory after exposure of the right sacral notch and bifurcation of the iliac vessels.
  • Comparable anatomic cure to sutures at 1 year — Yoshizawa 2021 reports 100% (tacker + suture combination) vs 94.4% (suture only), p = 0.22.[4]
  • Shorter operative time — 104.9 ± 27.0 vs 147.5 ± 33.7 min in the same series (p < 0.05).[4]
  • Significant lumbar-pain penalty — Vieillefosse 2015 found higher postoperative lumbar-pain intensity (VAS 4 vs 0, p = 0.01) and worse QoL across all domains in the tacker arm, even though the incidence of de-novo low back pain was not different (50% vs 25%, p = 0.11).[5]

Vaginal-mesh attachment (anchor variants)​

  • Berger 2020 RCT (robotic sacrocolpopexy) — absorbable barbed anchors for vaginal mesh attachment significantly faster than suturing (12.2 vs 21.2 min, p < 0.05); anatomical and patient-reported outcomes comparable.[6]

Where suture wins​

  • Stronger biomechanical fixation (64 N vs 41 N vs 15 N) and lower lumbar-pain intensity make suture the better default in most centers, particularly when long-term durability and patient-reported pain are weighted heavily.[3][5][7]
  • The Moroni 2018 systematic review of sacrocolpopexy technique found suture used in 11 / 18 studies describing sacral attachment, tackers in 4, mixed approach in 3 — confirming the global convention.[7]

Tacker vs Suture — The Decision​

FeatureHelical tacker (ProTack)Permanent suture
Fixation strength41 N (non-absorbable) / 15 N (absorbable)64 N
Failure modeMesh failure (non-absorbable) / tack pull-out (absorbable)Mesh failure
Operative timeSignificantly shorterLonger (intracorporeal knot-tying)
Anatomic cure at 1 yrEquivalent (100% vs 94.4%, NS)Reference
Postoperative lumbar pain intensityHigher (VAS 4 vs 0)Lower
QoL across domainsWorseBetter
Spondylodiscitis riskPossible (case reports)Possible (case reports)

Systematic-review verdict (Moroni 2018): level III evidence — tackers and permanent sutures equivalent in efficacy, but tackers carry a measurable lumbar-pain QoL penalty; permanent sutures remain the default.[7]

Safety Profile​

Spondylodiscitis / lumbosacral osteomyelitis​

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

  • Antosh 2024 case series + review (n = 30) — patients present with lower back pain at variable post-op intervals, elevated ESR / CRP; majority require mesh excision via laparotomy or laparoscopy plus prolonged IV antibiotics.[8]
  • Propst 2014 review — pyogenic spondylodiscitis after sacral colpopexy and rectopexy; same management principle.[9]

Vascular injury at the promontory​

  • The sacral promontory overlies the middle sacral vessels and presacral venous plexus; tacker penetration depth must be controlled. Mirkovic 1991 defined the safe-screw / safe-tack zone in spine surgery and informs urogyn fixation depth.[10]
  • Proper S1 identification and respect for the iliac bifurcation are mandatory before any tack throw.

Periosteal lumbar pain​

  • Titanium tacks penetrating the sacral periosteum likely explain the higher pain intensity in the tacker arm (Vieillefosse 2015).[5]

Other​

  • Mesh erosion / exposure — comparable across fixation methods; driven primarily by the vaginal-mesh interface.
  • Migration — case reports of tack migration; uncommon.

Emerging Alternatives​

  • Cyanoacrylate glue mesh fixation — Lamblin 2025 RCT found synthetic glue significantly reduced anterior-mesh fixation time (4.6 vs 25.4 min, p = 0.0001) with comparable anatomic success at 24 months (88.2% glue vs 73.7% sutures, NS). Promising sutureless / tackerless alternative pending broader uptake.[11]

Technique Considerations​

  • Identify the S1 promontory and the right sacral notch with the patient in Trendelenburg; mobilize the sigmoid laterally and identify the iliac bifurcation and the right ureter.
  • Open the peritoneum over the promontory; expose the anterior longitudinal ligament (white, glistening).
  • Place 3–5 tacks at right angles through the mesh into the ligament; avoid the midline middle sacral vessels and respect the iliac-bifurcation safe zone.
  • Close the peritoneum over the mesh to bury the fixation (reduces small-bowel adhesion to the mesh trajectory and may reduce post-op pain).
  • For mixed fixation (Yoshizawa technique), place a single permanent suture as the primary anchor and use tacks for time-efficient adjunctive fixation.[4]

Limitations​

  • Higher cost per case than suture-only fixation.
  • Pain trade-off — measurable lumbar-pain intensity penalty in patient-reported outcomes.
  • Absorbable tacks are biomechanically weakest and fail at the device itself; reserve for cases where permanent intraosseous material is undesired.

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