V176 ROBOTIC-ASSISTED LAPAROSCOPIC EXCISION OF SACROCOLPOPEXY MESH WITH EROSION INTO BLADDER: A NOVEL APPROACH

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V176 ROBOTIC-ASSISTED LAPAROSCOPIC EXCISION OF SACROCOLPOPEXY MESH WITH EROSION INTO BLADDER: A NOVEL APPROACH Ornob Roy and William Steers Ornob RoyOrnob Roy More articles by this author and William SteersWilliam Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.231AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abdominal sacrocolpopexy is a standard approach for surgical repair of vaginal vault prolapse. Despite advances in mesh materials, erosion into the vagina occurs at a rate of 0-9%, occasionally eroding into the bladder. Current techniques for excision of artificial mesh eroded into the bladder include open abdominal and vaginal exploration, as well as combined vaginal and endoscopic excision. We demonstrate a novel approach to excise polypropylene mesh eroded into the bladder using a robotic-assisted laparoscopic approach. METHODS The patient was positioned in low lithotomy and cystoscopy was used to place bilateral ureteral catheters prior to incision. The DaVinci surgical system was docked in-between the legs of the patient, similar to the position used for robotic-assisted laparoscopic radical prostatectomy (RALRP). Five ports were placed in a semilunar orientation centered around the pelvis similar to RALRP. The peritoneum was incised at the junction of the posterior bladder and vaginal cuff and a midline cystotomy was used to expose the eroded mesh within the bladder. After mesh removal, the bladder was closed in two layers with absorbable suture, and a suprapubic tube was placed for bladder drainage. RESULTS Total anesthesia time was 300 minutes, while robotic console time was 190 minutes. The mesh was densely adherent to the bladder, vaginal cuff, and small bowel; however, it was completely excised without evidence of entry into the vaginal vault. One small enterotomy was made during sharp dissection. This was immediately recognized and primarily repaired robotically. Preoperatively, the patient had exhibited signs and symptoms of irritative voiding, hematuria, infection, and bladder pain typical of mesh erosion into the bladder. The patient recovered well with no complications and the suprapubic catheter was removed after a negative cystogram two weeks postoperatively. CONCLUSIONS Robotic-assisted laparoscopic excision of mesh erosion into the bladder after sacroclpopexy is a viable alternative to open surgery. As a minimally-invasive technique, it may offer advantages of decreased postoperative hospital length of stay and decreased postoperative pain over open abdominal surgery. It also offers the potential for complete removal of the mesh which is not possible in endoscopic management. Further prospective study is required to determine its place in surgical management of this difficult problem. Charlottesville, VA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e70-e71 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ornob Roy More articles by this author William Steers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...