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Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: A Prospective Cohort Study.
J Minim Invasive Gynecol. 2019 May-Jun; 26(4):636-642.JM

Abstract

STUDY OBJECTIVE

To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort.

DESIGN

Prospective observational cohort study (Canadian Task Force classification II-2).

SETTING

Two large teaching hospitals with a tertiary referral function for pelvic floor disorders.

PATIENTS

Patients with symptomatic POP and simplified POP quantification (S-POP) stage ≥2. Patients with a history of mesh repair or concomitant insertion of a tension-free vaginal tape were excluded.

INTERVENTIONS

Robot-assisted laparoscopic sacrocolpopexy or robot-assisted laparoscopic supracervical hysterectomy with a sacrocervicopexy.

MEASUREMENTS AND MAIN RESULTS

A blinded vaginal examination with the aid of a transparent speculum was performed to look for mesh-related complications. Mesh exposures were described following the International Urogynecological Association/International Continence Society classification system. One hundred and ninety-two patients were included, of whom 166 (86.5%) were seen for follow-up examination. The median duration of follow-up was 15.7 months (range, 8.2-44.4 months). Two vaginal mesh exposures (1.2%) were detected, both of which were treated in the outpatient clinic. One patient without any complaints had a suture exposure, which was removed in the outpatient clinic.

CONCLUSION

The safety of the use of mesh in pelvic floor surgery is a matter of debate owing to the occurrence of mesh-related complications. Based on the current literature, mesh-related complications seem to be lower in transabdominal mesh surgery than in transvaginal mesh surgery. In this study, a low mesh exposure rate was observed in robot-assisted abdominal pelvic floor surgery for POP.

Authors+Show Affiliations

Meander Medical Center, Department of Gynecology, Amersfoort, The Netherlands (Drs van Zanten, Lenters, and Dr Schraffordt Koops); Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands (Drs van Zanten, Dr van Iersel, and Dr Broeders). Electronic address: f.van.zanten@meandermc.nl.Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands (Drs van Zanten, Dr van Iersel, and Dr Broeders); Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands (Dr van Iersel and Broeders).Department of Gynecology, Rijnstate Hospital, Arnhem, The Netherlands (Drs Hartog and Aalders).Department of Gynecology, Rijnstate Hospital, Arnhem, The Netherlands (Drs Hartog and Aalders).Meander Medical Center, Department of Gynecology, Amersfoort, The Netherlands (Drs van Zanten, Lenters, and Dr Schraffordt Koops).Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands (Drs van Zanten, Dr van Iersel, and Dr Broeders); Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands (Dr van Iersel and Broeders).Meander Medical Center, Department of Gynecology, Amersfoort, The Netherlands (Drs van Zanten, Lenters, and Dr Schraffordt Koops).

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29964179

Citation

van Zanten, Femke, et al. "Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: a Prospective Cohort Study." Journal of Minimally Invasive Gynecology, vol. 26, no. 4, 2019, pp. 636-642.
van Zanten F, van Iersel JJ, Hartog FE, et al. Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: A Prospective Cohort Study. J Minim Invasive Gynecol. 2019;26(4):636-642.
van Zanten, F., van Iersel, J. J., Hartog, F. E., Aalders, K. I. M., Lenters, E., Broeders, I. A. M. J., & Schraffordt Koops, S. E. (2019). Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: A Prospective Cohort Study. Journal of Minimally Invasive Gynecology, 26(4), 636-642. https://doi.org/10.1016/j.jmig.2018.06.015
van Zanten F, et al. Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: a Prospective Cohort Study. J Minim Invasive Gynecol. 2019;26(4):636-642. PubMed PMID: 29964179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: A Prospective Cohort Study. AU - van Zanten,Femke, AU - van Iersel,Jan J, AU - Hartog,Francis E, AU - Aalders,Karin I M, AU - Lenters,Egbert, AU - Broeders,Ivo A M J, AU - Schraffordt Koops,Steven E, Y1 - 2018/06/30/ PY - 2018/3/6/received PY - 2018/5/19/revised PY - 2018/6/20/accepted PY - 2018/7/3/pubmed PY - 2019/8/7/medline PY - 2018/7/3/entrez KW - Mesh erosion KW - Pelvic organ prolapse KW - Sacrocervicopexy KW - Sacrocolpopexy SP - 636 EP - 642 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 26 IS - 4 N2 - STUDY OBJECTIVE: To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort. DESIGN: Prospective observational cohort study (Canadian Task Force classification II-2). SETTING: Two large teaching hospitals with a tertiary referral function for pelvic floor disorders. PATIENTS: Patients with symptomatic POP and simplified POP quantification (S-POP) stage ≥2. Patients with a history of mesh repair or concomitant insertion of a tension-free vaginal tape were excluded. INTERVENTIONS: Robot-assisted laparoscopic sacrocolpopexy or robot-assisted laparoscopic supracervical hysterectomy with a sacrocervicopexy. MEASUREMENTS AND MAIN RESULTS: A blinded vaginal examination with the aid of a transparent speculum was performed to look for mesh-related complications. Mesh exposures were described following the International Urogynecological Association/International Continence Society classification system. One hundred and ninety-two patients were included, of whom 166 (86.5%) were seen for follow-up examination. The median duration of follow-up was 15.7 months (range, 8.2-44.4 months). Two vaginal mesh exposures (1.2%) were detected, both of which were treated in the outpatient clinic. One patient without any complaints had a suture exposure, which was removed in the outpatient clinic. CONCLUSION: The safety of the use of mesh in pelvic floor surgery is a matter of debate owing to the occurrence of mesh-related complications. Based on the current literature, mesh-related complications seem to be lower in transabdominal mesh surgery than in transvaginal mesh surgery. In this study, a low mesh exposure rate was observed in robot-assisted abdominal pelvic floor surgery for POP. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/29964179/Mesh_Exposure_After_Robot_Assisted_Laparoscopic_Pelvic_Floor_Surgery:_A_Prospective_Cohort_Study_ DB - PRIME DP - Unbound Medicine ER -