John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
Int Urogynecol J. 2020 Feb;31(2):411-413. doi: 10.1007/s00192-019-04088-4. Epub 2019 Sep 3.
The aim was to demonstrate laparoscopic complete excision of sacrocolpopexy mesh from a 65-year-old woman who had presented with delayed onset of persistent right-sided gluteal pain.
The patient was referred to our unit, having undergone a laparoscopic sacrocolpopexy for vault prolapse 7 years earlier, with a type 1 polypropylene mesh. Four years after the primary surgery, she first noticed symptoms of spontaneous vaginal pain together with deep dyspareunia, and right-sided gluteal pain. Clinical examination revealed mesh erosion at the vaginal vault. This was managed at her local hospital, with excision of the small exposed portion of the mesh and over sewing, from a vaginal approach. She continued to be symptomatic following this procedure. When her symptoms still failed to improve 3 years later, a tertiary referral was made to our unit. At laparoscopy, minimal adhesions between the bowel and the mesh were noted and divided. After carefully dissecting the right ureter and reflecting the bladder, the entire sacrocolpopexy mesh was removed with its ProTack fasteners. The entire specimen was retrieved in one piece through the open vault and the vagina was sutured with 2.0 <monocryl laparoscopically. Surgical steps begin with laparoscopic survey of the anatomy. Adhesions need to be released carefully, after developing proper surgical planes. On follow-up in clinic 12 weeks later, there was complete resolution of her symptoms, with minimal vault descent.
This video demonstrates the steps needed to undertake complete laparoscopic sacrocolpopexy mesh excision, which should be feasible for skilled laparoscopists. This approach has advantages over the open approach, with good access and visualisation of the entire course of the mesh, and more rapid recovery for the patient.
本视频旨在演示一例 65 岁女性腹腔镜下切除骶骨阴道固定术后补片的过程，该女性因右侧臀部持续性迟发性疼痛就诊。
患者因阴道前壁脱垂 7 年前接受腹腔镜骶骨阴道固定术，使用 1 型聚丙烯补片，术后 4 年首次出现自发性阴道疼痛和深部性交痛，伴右侧臀部疼痛。临床检查发现阴道穹窿处补片侵蚀。在当地医院通过阴道入路切除了一小部分暴露的补片并进行缝合。但此后患者仍有症状。3 年后症状仍未改善，转诊至我院。腹腔镜检查发现肠管与补片之间有轻微粘连，予以分离。仔细解剖右侧输尿管并翻转膀胱后，用 ProTack 紧固件完整取出整个骶骨阴道固定术补片。整个标本通过阴道开口整块取出，阴道用 2.0 可吸收线（monocryl）腹腔镜缝合。手术步骤从腹腔镜检查解剖开始。需要仔细释放粘连，在建立适当的手术平面后进行。术后 12 周门诊随访时，患者症状完全缓解，阴道穹窿轻微下降。
本视频演示了完成腹腔镜骶骨阴道固定术补片切除所需的步骤，对于熟练的腹腔镜医生来说是可行的。这种方法比开放式手术有优势，能够更好地进入和观察整个补片的走行，并使患者更快康复。
