Our recent video article, “Robotic Excision of Intravesical Mesh Following Transvaginal Mesh-Based Prolapse Repair”, published in the International Urogynecologic Journal, provides a step-by-step account of how we managed one such TVM prolapse mesh complication involving mesh perforation into the trigone of the bladder. In this instance, surgery included both transvesical mesh excision as well as left ureteral reimplantation. We chose a robotic approach, as this allowed for the best access to the posterior/inferior aspect of the bladder where the mesh perforation occurred and for ureteral reimplantation to be done in the same setting.
An important takeaway from our experience is the effective use of the robot to manage a urogynecologic mesh complication. Specifically, the use of the robot allowed us to minimize patient morbidity by avoiding a large open incision and significant bladder and ureteral mobilization. In addition, despite a difficult anatomic location deep in the pelvis at the bladder base, we had excellent visualization of the mesh and mobilization of the surrounding tissues, ensuring all the involved mesh was excised and optimizing tissue for tension-free reapproximation.
We do recognize that each prolapse TVM complication requires a nuanced approach to shared decision-making with the patient. We hope our report and associated robotic surgical video prove a useful example for other urogynecology providers seeking guidance on effectively managing unique mesh complications while minimizing patient morbidity.
Written by: Gabriela F. Sarriera Valentin,1 Francis A. Jefferson,2 Katherine T. Anderson,2 & Brian J. Linder2,3
- Larner College of Medicine, University of Vermont, Burlington, VT, USA.
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
- Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Read the Abstract