Laparoscopic Excision of Sacrocolpopexy Mesh |
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| Affiliation: | 1. Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;3. Department of Radiation Oncology, Dana-Farber/Brigham and Women''s Cancer Center, Harvard Medical School, Boston, Massachusetts;4. Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women''s Cancer Center, Harvard Medical School, Boston, Massachusetts;5. Department of Urology, Stanford University Medical Center, Stanford, California;6. Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan;1. Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, Massachusetts;2. Division of Plastic Surgery, Department of Surgery, Boston, Massachusetts;3. Department of Urology, Children''s Hospital Boston and Harvard Medical School, Boston, Massachusetts;4. Clinic of Plastic Surgery, University of Padova, Padova, Italy;1. Department of Obstetrics and Gynecology, Menoufia University, Menufia, Egypt;2. Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Kachsiung Medical University, Kaohsiung, Taiwan;3. Department of Obstetrics and Gynecology, St. Luke’s–Roosevelt Hospital, New York, New York;4. Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York |
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| Abstract: | Study ObjectiveTo demonstrate surgical maneuvers to facilitate laparoscopic excision of sacrocolpopexy mesh and prevent potential complications.DesignStep-by-step illustration of various surgical techniques using a video compiled from 3 laparoscopic sacrocolpopexy mesh excision procedures performed at Magee–Womens Hospital for various indications (Canadian Task Force classification xx-xx).SettingMesh complications such as infection and erosion are frequently managed conservatively but often necessitate mesh excision for symptom relief. Laparoscopic excision of sacrocolpopexy mesh procedures is typically challenging, even in the hands of experienced surgeons. Synthetic mesh, being a foreign body, activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy, thereby putting vital organs at risk of injury. Such organs include the bladder, rectum, and vagina caudally; the left common iliac vein and middle sacral vessels cephalad; and the ureters at the level of the vaginal cuff angles.InterventionLaparoscopic excision of sacrocolpopexy mesh.ConclusionWhen planning laparoscopic sacrocolpopexy mesh excision, complications can be prevented with use of proper surgical technique. It is important to identify vital structures because they may be displaced due to tissue fibrosis. When developing various surgical planes, surgeons should first operate in areas that are free of adhesions. This will enhance exposure when dissecting the mesh in proximity of scarred tissue and vital organs. Use of vaginal and rectal probes helps to delineate the vesicovaginal and rectovaginal spaces to prevent bladder and bowel injury. |
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| Keywords: | Laparoscopy Mesh complications Sacrocolpopexy mesh excision |
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