8574 Robotic-Assisted Correction of Sacrocolpopexy Mesh Erosion

Abstract

<h3>Study Objective</h3> This video highlights the technique for robotic-assisted laparoscopic correction of sacrocolpopexy mesh erosion into the vaginal cuff. <h3>Design</h3> N/A. <h3>Setting</h3> This surgery is performed at a tertiary teaching hospital. <h3>Patients or Participants</h3> 56-year-old gravida 1 para 1 with persistent vaginal discharge and intermittent bleeding, noted to have a retained foreign body eroding into the vaginal cuff ten years after undergoing abdominal hysterectomy due to pelvic organ prolapse. <h3>Interventions</h3> The patient underwent a robot-assisted laparoscopic excision of an eroded sacrocolpopexy mesh. After extensive adhesiolysis was performed, the pelvic sidewalls were opened, and bilateral ureterolysis was performed. The bladder was carefully dissected away from the vaginal cuff. Colpotomy was performed, and the eroded foreign body was visualized and identified as a mesh. Intraoperative cystoscopy confirmed there was no bladder erosion. The colpotomy was extended laterally, and the mesh was dissected using monopolar scissors. The presacral peritoneum was incised, and the presacral space was developed towards the cul de sac. The mesh was densely adhered to the right uterosacral ligament (USL) and extended cranially towards the sacral area. The mesh was transected at the level of the right USL and removed vaginally. The vaginal cuff was closed with a 0 polydioxanone suture in two layers. The left USL was then transfixed to the vaginal cuff. <h3>Measurements and Main Results</h3> The mesh was successfully removed, and the patient's symptoms resolved. <h3>Conclusion</h3> This approach offers optimal exposure and ease of access for excision in cases of vaginal mesh erosion. This can be especially beneficial in patients with dense adhesions from prior surgery. There are limited case reports describing laparoscopic correction of sacrocolpopexy mesh erosion, and further studies are necessary to compare this to the vaginal approach.