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Why laproscopic removal is not a good choice

Vaginal mesh is placed extra peritoneal. Outside the body cavity and away from bowels. Although laparoscopy is touted as minimally invasive, that is only to abdominal surgery. 

Vaginal surgery is less invasive than laparoscopic and robotic surgery. 
Robotic surgery is laparoscopic surgery aided by a computer to help the surgeon move the robotic arms. When mesh is placed vaginally and attempted to be removed laproscopically, the surgeon must place small 5mm to 12 mm incisions and ports in the abdomen. This does add a risk of injury to the bowel blood vessels as the trocars are inserted. 

Then the peritoneum must be cut and the bladder and vagina or rectum and vagina must be separated. Bear in mind that the instruments are inserted thru the abdomen. This port creates a fulcrum and the angle vertically thru the abdominal wall limits the instruments that are operating on the horizontal orientation of the vagina. 

While all this is going on you are tipped head down pelvis up so your bowels are out of harms way. The surgeon is operating standing at your side with thin 5mm to 10 mm instruments thru your abdomen to reach 17 to 25 inches from your vagina. 

Or, You can find a vaginal surgeon who can forgo all that and go directly thru the vagina to the mesh. Remember mesh was placed vaginally. The thin laparoscopic instruments were never designed for the structural stiffness of the mesh. Laparoscopic instruments were designed to be thin and delicate since bowel is always present. 

Additionally, laparoscopic surgery uses energy sources. Electricity to cut tissue and stop bleeding which generates heat. 

Mesh is plastic. Heat melts plastic. 

Due to the nonspecific delicate instruments used in laparoscopic and robotic surgery, in order to remove mesh in laparoscopic surgery, robotic energy must be used. 

The instruments are too weak. 

Removals done with the use of electricity will look blackened or burned with no clear edges or ends. And The small blood vessels need to be cauterized. 

Liberal use of energy will either melt the mesh, create a thermal injury in the tissue that will kill it days later and may result in a hole in the rectum or the bladder or in order to avoid melting the mesh, or more tissue will be removed and the chance of a hole and a Fistula will increase. 

Also, Mesh in the groins from a TOT and mesh under the skin and muscles from a TVT can NOT be accessed by laparoscopy. They need an incision.
You can do all that or have the mesh removed Vaginally with sharp dissection using more durable instruments designed specifically for Vaginal surgery. 

Written in response to inquiries about Laparoscopy By D.K. Veronikis M.D.

Your choice. 

Best chance is 1 surgery. Get out as much as possible. Preferably all of it from a surgeon with a known track record. 

You only have 1 chance to get it done right. 

Each surgery adds scar and risk of injury. 

Choose wisely.


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