V10-05: ROBOTIC-ASSISTED LAPAROSCOPIC SURGERY FOR BLADDER PERFORATION DUE TO POLYPROPYLENE SACROCOLPOPEXY MESH.
We present our technique of robotic assisted laparoscopic (RAL) surgery for treatment of International Continence Society (ICS)/International Urogynecological Association (IUGA) category 4 genitourinary prosthesis complications (lower urinary tract graft perforation). The objective of this video is to demonstrate key steps in RAL surgery for the management of bladder perforation by sacrocolpopexy mesh.
Retrospective review was conducted for 3 cases of RAL sacrocolpopexy mesh removal by a single surgeon between December 2013 and June 2017. Video recordings of these cases were reviewed to identify techniques utilized to facilitate completion these cases using the RAL approach. Key portions of the procedure are demonstrated in video from patient 3&[prime]s case.
All three cases were completed using RAL approach without need for conversion to an open procedure. Average patient age was 51 years. One patient presented with urinary incontinence, one with gross painless hematuria and the third patient presented with gross hematuria and bothersome lower urinary tract symptoms. All of these symptoms developed after prior abdominal sacrocolpopexy. Cystoscopy demonstrated mesh perforation involving the bladder in all three cases. Two patients had concomitant vesicovaginal fistula. Average operative time was 323.7 minutes (range 206-404) and the average length of hospitalization was 3 days (range 1-7). Repeat sacrocolpopexy was performed with cadaveric fascia in one case (patient 3), and this technique is demonstrated in the video. Rectovaginal, colovesical fistulae and post-operative urinary incontinence occurred in patient 2. No patients developed pelvic organ prolapse post-operatively.
RAL surgery is safe and effective for removal of polypropylene mesh in patients with ICS/IUGA category 4 complications. In our video, we demonstrate our approach for performing repeat sacrocolpopexy with cadaveric fascia at the time of mesh removal.