PFD Week 2016-Robotic-Assisted Excision of Transvaginal Mesh

Video Transcription

The objective of this video is to demonstrate how robotic-assisted removal of polypropylene transvaginal mesh is a good surgical option for patients after failed local excision.  Our patient is a 55-year-old, G6P4, presenting with complaints of persistent transvaginal mesh erosion despite multiple attempts at local excision, pelvic pain, and dyspareunia.  Her past surgical history is significant for placement of anterior and posterior prolift and four unsuccessful attempts at local excision of transvaginal mesh.  Therefore, the decision was made to attempt excision robotically. Local exam revealed exquisite pain on digital exam, multiple small, apical, and anterior vaginal wall erosions.  Banding was palpated at the left sacrospinous ligament. A bladder flap is created using the monopolar scissors and blunt dissection. The bladder flap is further dissected.  The right arm of the vaginal mesh is located and identified on the patient's right. A vaginal hand locates the mesh erosion.  This area is grasped and placed on tension to identify the course of the mesh arm. An area of vaginal mesh is visualized and grasped.  It is dissected off the anterior vaginal wall using blunt and sharp dissection. The Maryland bipolar forceps are exchanged for the prograsp forceps.  A plane is well established and blunt and sharp dissection is used to further dissect the mesh. A large piece of proximal mesh is excised and passed off the field.  The arm of the mesh is grasped and transected. The distal mesh is grasped and a vaginal hand is used to delineate the margins. The mesh is transected Blunt is further dissected  and excised. The arm of the mesh is grasped and transected. The area is inspected. Note the delineation of the right vaginal wall. These steps are repeated on the opposite side.  All anterior vaginal mesh was successfully removed. A vaginal exam was performed intraoperatively and no mesh erosion was appreciated. Her postoperative course was uncomplicated.  At her 6 week postoperative visit, our patients reported that she was pleased with her surgical results and had complete resolution of pain.  Physical exam revealed no anterior mesh palpated, no anterior mesh erosion was visualized, and no pain on digital exam.

Video Summary

The video demonstrates the robotic-assisted removal of polypropylene transvaginal mesh as a surgical option for patients who have previously undergone unsuccessful attempts at local excision. The patient in the video is a 55-year-old woman who had experienced persistent transvaginal mesh erosion, pelvic pain, and dyspareunia. The surgery involved creating a bladder flap, locating and identifying the vaginal mesh, dissecting it off the vaginal walls using various instruments, and excising the mesh piece by piece. The entire anterior vaginal mesh was successfully removed, and the patient reported complete resolution of pain during the postoperative visit. No complications were reported.

Asset Subtitle

Kathryn Williams, MD

Keywords

robotic-assisted removal

polypropylene transvaginal mesh

surgical option

local excision

mesh erosion