Department of Gynecology, Mayo Clinic, Phoenix, Arizona (all authors)..
Department of Gynecology, Mayo Clinic, Phoenix, Arizona (all authors).
J Minim Invasive Gynecol. 2019 Nov-Dec;26(7):1226. doi: 10.1016/j.jmig.2019.04.016. Epub 2019 Apr 18.
To describe a standardized technique for robotic complete excision of sacrocolpopexy mesh.
A step by step video demonstration of the technique.
A tertiary care academic hospital.
Three patients with persistent pain after sacrocolpopexy mesh insertion. Although exposure can usually be controlled with partial mesh removal, complete excision may be required for patients with persistent pain, exposure, or severe infection. Because of the inherent inflammation, fibrosis, and distortion of tissue planes with mesh augmentation, removal should be performed in a methodical fashion, preparing for possible visceral injury.
Robotic-assisted sacrocolpopexy mesh removal.
This video (Video 1) presents a systematic, minimally invasive approach to sacrocolpopexy mesh removal, highlighting the technical and anatomic aspects that can facilitate the procedure. Retroperitoneal dissection along with identification of the anatomic landmarks, such as the sacral promontory, iliac vessels, right ureter, bladder, and rectum, are critical. Backfilling the bladder and the use of vaginal and rectal probes can also optimize difficult tissue planes. In each compartment, identifying the whole mesh before starting its removal may prevent leaving mesh fragments. The caudal to cranial and lateral to medial approach facilitates the extraction of the synthetic tissue. Removing the sacral mesh last allows the attachment to be used as a point of traction. Superior dissection of the mesh requires careful dissection and recognition of great vessels along with autonomic nervous structures such as the superior hypogastric plexus.
Minimally invasive removal of sacrocolpopexy mesh can be standardized using this step by step approach.
描述一种机器人辅助全切除骶骨阴道固定网片的标准化技术。
该技术的分步视频演示。
三级护理学术医院。
三例因骶骨阴道固定网片置入后持续疼痛的患者。虽然通常可以通过部分网片切除来控制暴露，但对于持续疼痛、暴露或严重感染的患者，可能需要完全切除。由于网片增强导致组织平面固有炎症、纤维化和扭曲，因此应采用有条不紊的方法进行移除，为可能的内脏损伤做好准备。
机器人辅助骶骨阴道固定网片切除术。
本视频（视频 1）介绍了一种系统的、微创的骶骨阴道固定网片切除方法，强调了有助于手术的技术和解剖方面。腹膜后解剖，同时识别解剖标志，如骶骨岬、髂血管、右侧输尿管、膀胱和直肠，至关重要。膀胱充盈和使用阴道和直肠探针也可以优化困难的组织平面。在每个隔室中，在开始移除网片之前识别整个网片，可防止留下网片碎片。从尾侧向头侧和从外侧向内侧的方法有助于提取合成组织。最后移除骶骨网片可使附着处用作牵引点。网片的上侧解剖需要小心解剖，并识别大血管以及自主神经结构，如腹下丛。
采用这种逐步方法，可以将骶骨阴道固定网片的微创切除标准化。
