Laparoscopic Excision of Sacrocolpopexy Mesh Dina Chamsy, MD*, and Ted Lee, MD From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee–Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (both authors).
ABSTRACT Study Objective: To demonstrate surgical maneuvers to facilitate laparoscopic excision of sacrocolpopexy mesh and prevent potential complications. Design: Step-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). Setting: Mesh 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. Intervention: Laparoscopic excision of sacrocolpopexy mesh. Conclusion: When 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. Journal of Minimally Invasive Gynecology (2014) 21, 986 Ó 2014 AAGL. All rights reserved. Keywords:
DISCUSS
Laparoscopy; Mesh complications; Sacrocolpopexy mesh excision Use your Smartphone to scan this QR code and connect to the discussion forum for this article now*
You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-22-1-JMIG-D-14-00325
* Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
Supplementary Data Supplementary data related to this article can be found online at http://dx.doi.org/10.1016/j.jmig.2014.07.011.
Corresponding author: Dina Chamsy, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee–Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15221. E-mail: [email protected] 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2014.07.011
Submitted June 30, 2014. Accepted for publication July 6, 2014. Available at www.sciencedirect.com and www.jmig.org
ABSTRACT Study Objective: To demonstrate surgical maneuvers to facilitate laparoscopic excision of sacrocolpopexy mesh and prevent potential complications. Design: Step-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). Setting: Mesh 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. Intervention: Laparoscopic excision of sacrocolpopexy mesh. Conclusion: When 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. Journal of Minimally Invasive Gynecology (2014) 21, 986 Ó 2014 AAGL. All rights reserved. Keywords:
DISCUSS
Laparoscopy; Mesh complications; Sacrocolpopexy mesh excision Use your Smartphone to scan this QR code and connect to the discussion forum for this article now*
You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-22-1-JMIG-D-14-00325
* Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
Supplementary Data Supplementary data related to this article can be found online at http://dx.doi.org/10.1016/j.jmig.2014.07.011.
Corresponding author: Dina Chamsy, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee–Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15221. E-mail: [email protected] 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2014.07.011
Submitted June 30, 2014. Accepted for publication July 6, 2014. Available at www.sciencedirect.com and www.jmig.org
