In the domain of pelvic floor surgery, managing complications from synthetic mesh implantation is challenging. This video showcases a complex case of sacrocolpopexy mesh removal using robotic-assisted techniques, highlighting the evolving capacities of robotic surgery in addressing intricate mesh-related complications. By sharing this case study, we aim to provide insights for surgeons facing similar scenarios in pelvic floor reconstruction.

We present a 61-year-old non-smoking, active female, with a BMI of 21.3 and 2 previous pregnancies and vaginal deliveries. She has a past history of an open prolapse surgery in 1998, followed by a robotic-assisted sacrocolpopexy with mesh in 2019 and a TVT in 2021 for SUI. Following TVT, her SUI improved. However, in January 2023 she sought consultation for increased urinary frequency and recurrent UTIs. Cystoscopy revealed bladder trigone deposits, suggesting mesh erosion. Pelvic MRI disclosed collections around the mesh with heterogenous content. After thorough discussion, comprehensive robotic-assisted mesh removal warranted.

Bilateral double J ureteral stents were placed endoscopically at the begining of the procedure. Opening the bladder facilitated thorough mesh removal. The surgery took approximately 3h30min with no post-operative complications. The patient was discharged after 2 days, removing the bladder catheter on day 7. Stents were removed a month post-surgery. Despite resolution of LUTS, discomfort and recurrence of the prolapse led to a transvaginal correction in March of 2024. Since then, she has remained symptom-free, content, and active.

This video underscores the significance advanced surgical techniques in addressing complex mesh-related complications. The meticulous approach shown aligns with the evolving consensus advocating comprehensive mesh excision. Evidence supports minimally invasive procedures, improving outcomes and reduced morbidity. Documenting such cases  contribute to the growing body of knowledge in pelvic floor surgery, aiming for enhanced functional outcomes and refined practices in the management of mesh-related complications.