V2-08: Robotic-assisted laparoscopic removal of extruded sacrocolpopexy mesh
VideoIntroductions and Objectives
Mesh sacrocolpopexy is an effective treatment strategy for both high grade and refractory pelvic organ prolapse. Graft erosion into the vagina, bladder or urethra, however, is a recognized complication of nonabsorbable mesh and can result in significant morbidity. The management of an eroded sacrocolpopexy mesh can be technically challenging and traditionally requires an abdominal laparotomy which carries its own perioperative morbidity. We demonstrate a minimally invasive robotic approach to removing the sacrocolpopexy mesh extruding in the vagina.
Vaginal exam demonstrated the extruded mesh at the apex of the vagina. With the patient in Trendenlenberg position and employing robotic assistance, the pelvis was thoroughly examined. The Sigmoid colon was identified, mobilized and reflected laterally, hence exposing the sacral promontory. A fibrous band enveloping the mesh was identified from the sacral promontory to the apex of the vagina. The mesh was dissected and excised in its entirety. A vaginotomy was performed to access the vagina portion of the mesh and this was excised. The vaginal defect was closed in two layers and a foley catheter was placed.
Duration of procedure was 150 minutes. Estimated blood loss was 10cc. Vaginal packing and foley catheter were placed postoperatively and removed on postoperative day 1. Currently, the patient reports resolution of her lower back pain and vaginal discharge as well as improvement in dyspareunia symptoms.
Transabdominal robotic-assisted laparoscopic removal of sacrocolpopexy mesh is an effective, safe, and less morbid alternative to the traditional open approach for the management of mesh extrusion.