The Avaulta system uses the same type of mesh used in the ProLift system. That is, it uses a monofilament polypropylene mesh. The lateral perforation points deep in the vagina are at the ischial spines, just as is used in the anterior ProLift. The main advantage of the Avulta system is that, built into the handle of the mesh introducer is a wire that advances through the introducer and out the vaginal incision toward the surgeon, allowing for easier deployment of the mesh arms, particularly for the less experience surgeon. The wire then snares, or grabs the mesh arm and retracts the wire back in to the introducer and allows the mesh to be pulled out lateral to the levator muscles. This device also avoids the sacrospinous ligament which in theory may improve the safety of the device.
To date there are no head to head studies comparing the safety or efficacy of the various devices available to surgeons. Choice of device is mostly surgeon preference. Subtle differences between devices may eventually prove advantageous to the most experience surgeon, but only large multicenter surgical trials will eventually allow us to understand if any true advantages exist.
