V1-09: Robotic Assisted Laparoscopic Excision of Retropubic Mesh

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Introductions and Objectives
Mesh complications can cause significant morbidity. Fortunately, conservative management can often be successfully employed. However, when conservative measures fail, minimally invasive management strategies should be considered. Few case reports exist and to our knowledge, no long term studies exist in the literature. Herein, we describe our experience with robotic assisted excision of retropubic and intravesical mesh.

Methods
The index patient is 40 yr old multiparous female 8 years status post Gynecare TVT retropubic mid urethral sling who presented with new onset of pelvic pain, recurrent UTIs, dyspareunia, dysuria and unaware incontinence. Initial work up revealed exposed intravesical mesh with associated large bladder stones. After failing conservative management, the patient underwent robotic excision of retropubic and intravesical mesh.

Results
Robotic excision of retropubic mesh was performed, ensuring complete resection of mesh, cystotomy repair and adequate post operative drainage. The patient had an uneventful hospital stay, discharged post operative day (POD) 1. Foley catheter was removed POD 3. Pelvic pain and dysuria resolved at one month follow up.

Conclusions
Open, endoscopic and pure laparoscopic techniques have been described, however robotic assisted laparoscopic excision provides optimal manual dexterity, magnification and depth perception. However, there are limitations. The additional cost of robotic surgery is an ongoing area of debate and the issues with access to a robot can be prohibitive. There is a paucity of data on the robotic assisted laparoscopic management of mesh complications. Few case reports exist and to our knowledge no long term studies exist in the literature. In our experience, robotic excision of retropubic mesh is a safe and effective management option for recalcitrant retropubic intravesical mesh exposure. Future directions include utilization of extraperitoneal access.

Funding: none