The removal of tension-free vaginal tape (TVT) mesh due to complications such as chronic pain, erosion, or voiding dysfunction is typically performed via a vaginal approach. However, in complex cases—particularly when preoperative imaging indicates mesh positioning at the bladder neck—a transperitoneal approach, either laparoscopic or robotic, may offer distinct advantages. This video presents a case of symptomatic TVT mesh requiring laparoscopic removal, highlighting the benefits of this technique over the vaginal approach in anatomically challenging cases.

This clinical video details the case of a 55-year-old female patient who underwent TVT mesh implantation in 2002. In 2022, she presented with infravesical obstruction and underwent a transvaginal partial mesh removal via anterior colpotomy. Following this procedure, the patient developed mixed urinary incontinence with urgency predominance and dyspareunia.

Vaginal examination revealed no mesh extrusion but bilateral palpation of both mesh arms, with no periurethral mesh. Hypersensitivity and pain were noted on palpation of the right mesh arm. Urodynamic studies indicated reduced bladder capacity, detrusor overactivity, and secondary incontinence. Urethrocystoscopy identified a 1.5 cm calculus adhered to a mesh extrusion at the right bladder neck. Transvaginal ultrasound confirmed mesh persistence at the bladder neck with associated lithiasis.

A combined endoscopic and laparoscopic approach was planned for complete mesh removal and lithiasis extraction. The operative steps are demonstrated in the video.

The laparoscopic approach provided superior visualization of the pelvic structures, facilitating the safe and complete removal of the mesh and adhered lithiasis, particularly during the dissection of the transdetrusor right mesh arm. Additionally, it allowed for appropriate bladder and vaginal reconstruction.

The patient experienced an uneventful recovery. A bladder catheter was maintained until a follow-up urethrocystography at four weeks confirmed the absence of urinary leakage and post-void residual urine. After catheter removal, the patient reported significant improvement in pain and urgency incontinence, with only mild persistent stress incontinence.

This clinical video highlights the transperitoneal approach as a valuable alternative to vaginal TVT mesh removal in selected patients, particularly those with preoperative evidence of mesh positioning at the bladder neck or prior failed vaginal surgeries. The laparoscopic or robotic technique offers enhanced visualization and enables precise bladder and bladder neck reconstruction when needed, reinforcing its role in managing complex cases