A 55-year-old patient was referred from Oncological Gynecology Unit to the Urogynecology Unit as during a exploratory laparoscopy under suspicion of vaginal cancer, it was discovered intraoperative a vaginal mesh erosion.
The patient was unaware that 14 years ago she had undergone a vaginal hysterectomy, and ten years later, in the context of a dome prolapse, she had been under a laparoscopic sacrocolpopexy where a mesh and helical sutures at the level of the elevator muscle, vagina and sacral promontory were impanated. The patient’s history was uneventful without dyspareunia, incontinence, or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. But, some months ago, she had begun with symptomatic increasingly foul-smelling vaginal discharge, and after a while she was referring vaginal bleeding.
Laparoscopic sacrocolpopexy shows superior outcomes for pelvic organ prolapse, with success rates of up to 96%, although an uncommon side effect might be a mesh erosion, occurring in up to 2.4%. In this video we show an alternative route for the excision of a symptomatic exposed mesh, as usually these are usually treated laparoscopically, in our case we performed a transvaginal approach based with the vNOTES.
The gel single-port platform was placed vaginally, and laparoscopic instruments were used as the mesh exposition was more than 10 cm away from the vaginal introitus and was Inaccessible through the classic vaginal route. The vNOTES device allowed us to see properly the exposed mesh to remove completely together with two helical anchorages that were also exposed. There were no signs of further infection of the residual mesh beyond the area exposed in the vagina. No complications occurred in the postoperative course and the follow-up visit first and second month postoperatively the patient is asymptomatic, and the vaginal examination shows no recurrence neither other complications.