Anchorsure Versus Capio for Sacrospinous Ligament Fixation

NCT ID: NCT03565640

Last Updated: 2023-02-16

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-29

Study Completion Date

2022-01-26

Brief Summary

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Sacrospinous ligament fixation is a common method of repairing apical support for pelvic organ prolapse but it currently suffers from a high rate of postoperative buttock and posterior thigh pain. Anchorsure® is a relatively new FDA-approved device that uses an anchor instead of the widely-used suture capturing mechanism to perform sacrospinous ligament fixation. The study hypothesis is that Anchorsure® will reduce the degree and rate of buttock and posterior thigh pain compared to the widely used Capio™ Slim suturing capturing Device.

Detailed Description

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Sacrospinous ligament fixation is a common method of repairing apical support for pelvic organ prolapse but it currently suffers from a high rate of postoperative buttock and posterior thigh pain. Rates of buttock and thigh pain 6 weeks after sacrospinous ligament fixation with the widely used Capio™ Slim device (Boston Scientific) are about 15-16% with immediate postoperative pain occurring in 55-84% of patients. This study is a randomized controlled single-blind study with the primary goal of investigating if there is an improvement in the intensity and rate of buttock and posterior thigh pain 1 day, 7 days, 6 weeks, and minimum 12 months after sacrospinous ligament fixation with a new device, the Anchorsure® Suture Anchoring System (Neomedic) compared to the widely utilized Capio™ Slim (Boston Scientific) device. 60 patients will be enrolled to undergo sacrospinous ligament fixation for treatment of pelvic organ prolapse. The patients will be randomized into two study groups; one will have sacrospinous ligament fixation using the Capio™ Slim device and the other with the Anchorsure® device. The patient's pain will be recorded via the numerical rating scale (NRS), a validated pain evaluation tool. The study is powered to detect a 2.5 point difference in pain between the two groups, a value that has been shown in studies to be clinically significant to acute pain patients. Secondary outcomes of surgeon satisfaction and efficiency with the devices will be assessed via surgeon questionnaires.

Conditions

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Postoperative Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants
Participants and research staff will be masked during the study as much as possible, however there will be a description of the type of sacrospinous ligament fixation device used within the body of the operative note for each patient that research staff could gain access to

Study Groups

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Capio Slim Device

Participants will be randomized to the sacrospinous ligament fixation with use of Capio Slim Device

Group Type ACTIVE_COMPARATOR

Capio Slim Device

Intervention Type DEVICE

Participants who have been assigned to sacrospinous ligament fixation for pelvic organ prolapse will have sacrospinous ligament fixation performed with the Capio Slim Device.

Anchorsure Device

Participants will be randomized to the sacrospinous ligament fixation with use of Anchorsure Device

Group Type EXPERIMENTAL

Anchorsure Device

Intervention Type DEVICE

Participants who have been assigned to sacrospinous ligament fixation for pelvic organ prolapse will have sacrospinous ligament fixation performed with the Anchorsure Device.

Interventions

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Capio Slim Device

Participants who have been assigned to sacrospinous ligament fixation for pelvic organ prolapse will have sacrospinous ligament fixation performed with the Capio Slim Device.

Intervention Type DEVICE

Anchorsure Device

Participants who have been assigned to sacrospinous ligament fixation for pelvic organ prolapse will have sacrospinous ligament fixation performed with the Anchorsure Device.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Female patients
* At least 21 years of age
* Surgical plan that includes a native tissue vaginal repair with apical support via sacrospinous ligament fixation. We will permit both hysteropexy and post-hysterectomy sacrospinous ligament suspension
* Understanding and acceptance of the need to return for the 6 week follow-up visit
* English speaking and able to give informed consent
* Willing and able to complete all study questionnaires
* Ambulatory

Exclusion Criteria

* Prior sacrospinous ligament fixation procedure.
* Any serious disease or chronic condition that could interfere with the study compliance
* Inability to give informed consent
* Pregnancy or planning pregnancy prior to the 6 week postoperative visit
* Prior pelvic radiation
* Incarcerated
* Prior augmented (synthetic mesh, autologous graft, xenograft, allograft) prolapse repair
* History of significant buttock or leg pain in the past 3 months
* History of fibromyalgia, polymyositis, dermatomyositis, systemic lupus erythematosus, or other auto-immune myalgic conditions
* Current regular opioid drug therapy for any chronic pain condition
* History of loss of motor or sensory function of the lower extremities
* History of sacral decubitus ulcers
* Planned concomitant levatorplasty; anal sphincteroplasty, anal fissurectomy, rectopexy, or hemorrhoidectomy
Minimum Eligible Age

21 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Catherine Matthews, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Wake Forest Baptist Medical Center

Winston-Salem, North Carolina, United States

Site Status

Countries

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United States

References

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Karacaoglu MU, Ozyurek ES, Mutlu S, Odacilar E. Unilateral sacrospinous ligament fixation (USLF) with a mesh stabilizing anchor set: clinical outcome and impact on quality of life. Clin Exp Obstet Gynecol. 2016;43(2):216-9.

Reference Type BACKGROUND
PMID: 27132413 (View on PubMed)

Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM. Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol. 2001 Jul;98(1):40-4. doi: 10.1016/s0029-7844(01)01378-3.

Reference Type BACKGROUND
PMID: 11430954 (View on PubMed)

Mowat A, Wong V, Goh J, Krause H, Pelecanos A, Higgs P. A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation. Aust N Z J Obstet Gynaecol. 2018 Feb;58(1):119-124. doi: 10.1111/ajo.12720. Epub 2017 Sep 22.

Reference Type BACKGROUND
PMID: 28940223 (View on PubMed)

Barber MD, Chen Z, Lukacz E, Markland A, Wai C, Brubaker L, Nygaard I, Weidner A, Janz NK, Spino C. Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). Neurourol Urodyn. 2011 Apr;30(4):541-6. doi: 10.1002/nau.20934. Epub 2011 Feb 22.

Reference Type BACKGROUND
PMID: 21344495 (View on PubMed)

Atherton MJ, Daborn JP, Tsokos N, Jeffery JT, Yin MJ. Complications associated with tissue anchor migration after vaginal surgery using the tissue fixation system - a case series. Aust N Z J Obstet Gynaecol. 2012 Feb;52(1):83-6. doi: 10.1111/j.1479-828X.2011.01383.x. Epub 2011 Dec 6.

Reference Type BACKGROUND
PMID: 22141331 (View on PubMed)

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005 Jul;193(1):103-13. doi: 10.1016/j.ajog.2004.12.025.

Reference Type BACKGROUND
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Brennand EA, Bhayana D, Tang S, Birch C, Murphy M, Cenaiko D, Ross S, Robert M. Anchor placement and subsequent movement in a mesh kit with self-fixating tips: 6-month follow-up of a prospective cohort. BJOG. 2014 Apr;121(5):634-40. doi: 10.1111/1471-0528.12536. Epub 2014 Jan 13.

Reference Type BACKGROUND
PMID: 24621073 (View on PubMed)

Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10-7. doi: 10.1016/s0002-9378(96)70243-0.

Reference Type BACKGROUND
PMID: 8694033 (View on PubMed)

Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB. What decline in pain intensity is meaningful to patients with acute pain? Pain. 2003 Sep;105(1-2):151-7. doi: 10.1016/s0304-3959(03)00176-3.

Reference Type BACKGROUND
PMID: 14499431 (View on PubMed)

DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1717-24; discussion 1724-8. doi: 10.1016/0002-9378(92)91562-o.

Reference Type BACKGROUND
PMID: 1615980 (View on PubMed)

Eilber KS, Alperin M, Khan A, Wu N, Pashos CL, Clemens JQ, Anger JT. Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support. Obstet Gynecol. 2013 Nov;122(5):981-987. doi: 10.1097/AOG.0b013e3182a8a5e4.

Reference Type BACKGROUND
PMID: 24104778 (View on PubMed)

Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage. 2003 May;25(5):406-11. doi: 10.1016/s0885-3924(03)00162-3.

Reference Type BACKGROUND
PMID: 12727037 (View on PubMed)

Ferrando CA, Walters MD. A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. Am J Obstet Gynecol. 2018 Jun;218(6):599.e1-599.e8. doi: 10.1016/j.ajog.2018.03.033. Epub 2018 Mar 31.

Reference Type BACKGROUND
PMID: 29614274 (View on PubMed)

Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006 Jan;15 Suppl 1(Suppl 1):S17-24. doi: 10.1007/s00586-005-1044-x. Epub 2005 Dec 1.

Reference Type BACKGROUND
PMID: 16320034 (View on PubMed)

Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011 Jun;41(6):1073-93. doi: 10.1016/j.jpainsymman.2010.08.016.

Reference Type BACKGROUND
PMID: 21621130 (View on PubMed)

Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jan;19(1):137-42. doi: 10.1007/s00192-007-0405-x. Epub 2007 Jun 20.

Reference Type BACKGROUND
PMID: 17579801 (View on PubMed)

Inoue H, Sekiguchi Y, Kohata Y, Satono Y, Hishikawa K, Tominaga T, Oobayashi M. Tissue fixation system (TFS) to repair uterovaginal prolapse with uterine preservation: a preliminary report on perioperative complications and safety. J Obstet Gynaecol Res. 2009 Apr;35(2):346-53. doi: 10.1111/j.1447-0756.2008.00947.x.

Reference Type BACKGROUND
PMID: 19708181 (View on PubMed)

Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010 Nov;116(5):1096-100. doi: 10.1097/AOG.0b013e3181f73729.

Reference Type BACKGROUND
PMID: 20966694 (View on PubMed)

Stanford EJ, Moore RD, Roovers JP, Courtieu C, Lukban JC, Bataller E, Liedl B, Sutherland SE. Elevate anterior/apical: 12-month data showing safety and efficacy in surgical treatment of pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2013 Mar-Apr;19(2):79-83. doi: 10.1097/SPV.0b013e318278cc29.

Reference Type BACKGROUND
PMID: 23442504 (View on PubMed)

Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006 May;194(5):1438-43. doi: 10.1016/j.ajog.2006.01.057. Epub 2006 Mar 30.

Reference Type BACKGROUND
PMID: 16579933 (View on PubMed)

Unger CA, Walters MD. Gluteal and posterior thigh pain in the postoperative period and the need for intervention after sacrospinous ligament colpopexy. Female Pelvic Med Reconstr Surg. 2014 Jul-Aug;20(4):208-11. doi: 10.1097/SPV.0000000000000091.

Reference Type BACKGROUND
PMID: 24978086 (View on PubMed)

Plair A, Smith W, Hines K, Schachar J, Parker-Autry C, Matthews C. 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 Jan 1;139(1):97-106. doi: 10.1097/AOG.0000000000004629.

Reference Type DERIVED
PMID: 34856573 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

Access external resources that provide additional context or updates about the study.

https://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/UCM262760.pdf

FDA 2011 Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse

https://www.ics.org/2017/abstract/850

SOUSA A, FLORES J, LEON J, SOUSA-GONZALEZ D. ICS 2017 Annual Meeting, Florence. Non-Discussion Video #850: RESULTS OF EFFICIENCY AND SAFETY IN REPAIRING PREVIOUS PROLAPSE THROUGH THE SURELIFT® SYSTEM. 5 YEARS RESULTS

https://www.ics.org/2010/abstract/864

AMAT L, GOMEZ A, MARTINEZ E, KAPLAN E. ICS 2010 Annual Meeting, Toronto. Non-Discussion Video #864: EVALUATION OF THE SAFETY AND EFFICACY OF PELVIC ORGAN PROLAPSE REPAIR USING SURELIFT® SYSTEM - PRELIMINARY RESULTS

https://academy.iuga.org/iuga/2015/40th/142097/xinxin.lin.surgical.treatment.of.genital.prolapse.with.surelift.mesh.in.html

LIN X, et al. 2015 IUGA Annual Meeting, Nice. Non-Discussed Poster #NDP310: SURGICAL TREATMENT OF GENITAL PROLAPSE WITH SURELIFT® MESH IN PATIENTS AT RISK OF RECURRENCE

Other Identifiers

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IRB00051211

Identifier Type: -

Identifier Source: org_study_id

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