Sacrocolpopexy (SCP) is a standard surgical procedure performed to address pelvic organ prolapse. Though uncommon, SCP mesh or sutures can cause perforation or exposure into neighboring structures such as the bladder, rectum, or vagina. Management includes partial excision, laser of mesh in the bladder, or complete removal of the affected mesh arm. In this video we will demonstrate a robotic abdominal approach to excision of SCP mesh with bladder perforation and vaginal exposure.

With the patient in steep Trendelenburg, the Da Vinci Xi Robot was used to remove the affected anterior mesh arm. Peritoneum overlying the mesh was opened and the anterior vaginal mesh was dissected free, taking care to leave the mesh intact at the vaginal apex. Permanent Gore-Tex sutures were encountered and excised. A cystotomy and vaginotomy were encountered and both were closed in multiple layers and were non-overlapping.

The patient was discharged home the same day with indwelling foley catheter in place for two weeks. At a postoperative visit she was recovering well. Only removing the affected mesh arm allowed continued vaginal apical support.

Mesh perforation and exposure is rare, but measures can be taken to prevent these complications. Prevention strategies include avoiding direct mesh placement on any vaginotomy or cystotomy. Delayed absorbable monofilament suture is non-inferior to permanent suture. We recommend complete excision of the mesh arm via a minimally invasive intra-abdominal approach, as lasering or partial excision may lead to repeated perforation or exposure at the resected edges.