V2-09: Robotic-Assisted Mesh Explantation and Bladder Reconstruction
VideoIntroductions and Objectives
In 2008, the FDA released a statement regarding the complications associated with trans-vaginal placement of mesh during repair of pelvic organ prolapse. Post-operative complications including mesh erosion and infection have been reported in many cases. Management of mesh erosion can be difficult, in some cases requiring multiple operative interventions. We present our experience with a mesh erosion into the mid-trigone following trans-vaginal mesh repair of pelvic organ prolapse. Our purpose is to demonstrate a minimally invasive technique to management of intravesical erosion of mesh.
This is video presentation of a case report involving robotic assisted laparoscopic extraction of mesh into the mid-trigone. Surgical technique and case details are displayed, including pertinent patient information. Pre-operative cystoscopic images are included for teaching purposes.
Successful robotic assisted explantation of eroded mesh with complex reconstruction of bladder was achieved. The patient was hospitalized overnight, and there were no immediate perioperative complications. Post operatively patient had resolution of all lower urinary tract symptoms. At six month follow-up, no recurrent urinary tract infections, dysuria, frequency, or urgency remain. The patient was hospitalized overnight, and there were no immediate perioperative complications.
Surgical management of trans-vaginal mesh erosions can be difficult. Conservative approaches, such as cystoscopic management, can be ineffective for complex cases. In appropriately selected cases, robotic-assisted approaches can provide a useful tool in the surgeons armamentarium. Further research is needed to delineate cost-effectiveness, and operative outcomes when compared to traditional approaches.