Complete Extraperitoneal Sacrocolpopexy with PVDF Visible Mesh Implant
Sacrocolpopexy is a standard procedure for the treatment of genital prolapse in women. It connects two extraperitoneally located structures, the sacrum and the vaginal cuff. In contrast to the usual transperitoneal route (open or laparoscopic) it appears reasonable to proceed extraperitoneally from the beginning and leave the peritoneal cavity unharmed. This method was introduced by Onol et al. in 2011. The utilization of PVDF (Polyvinylidenfluoride) mesh loaded with iron particles for hernia repair in humans and the visualization on MRI was first reported by Hansen et al. in 2013. We present a novel technique with a combination of these two innovative methods.
From 06/2014 to 10/2017 15 patients had a completely extraperitoneal sacrocolpopexy with PVDF visible mesh implant (DynaMesh® PR visible, Aachen, Germany). Five patients had a concomitant burch colposuspension for stress urinary incontinence. In selected patients pre- and postoperative dynamic MRI studies were conducted for the evaluation of the pelvic floor defect and its correction together with the demonstration of the visible mesh implant. In addition 3D images and animations were created from the MRI data sets.
In all 15 cases a complete anatomic and functional correction of the prolapse was achieved. No complications occurred. The surgical technique is demonstrated step by step. The mesh implant could be clearly visualized with the MRI settings for hernia meshes. Dynamic sequences could well demonstrate the shape and position of the mesh and the correction of the pelvic floor defect. With 3D graphical software the structures of the pelvic bones and organs were added to the mesh animations and therefore the actual result of the pelvic floor repair could be visualized. These 3D reconstructions offer an isolated view of the postoperative behaviour of the mesh and also of the relation to the adjacent organs.
The extraperitoneal sacrocolpopexy is an excellent procedure for the correction of genital prolapse in women and less harmful than the transperitoneal approach. The utilization of the PVDF visible mesh implants enables the visualization of the surgical result and possible sequelae. Further enhanced 3D animations of the mesh and pelvic organs offer new perspectives for scientific purposes and for future developments in pelvic floor surgery.