While the data regarding synthetic midurethral slings removal have been increasing over the
past decade, the literature regarding mesh for pelvic organ prolapse (POP) removal remain scant. Recently, the robotic approach for POP mesh removal have been introduced but there is still no data available.
The aim of the present study was to report the outcomes of robotic POP mesh removal.

The charts of all consecutive patients who underwent robotic POP mesh removal at a single
academic center were retrospectively reviewed. Procedures performed via open, vaginal or
conventional laparoscopic approach were excluded.
The patients were divided in four descriptive subgroups, not intended for comparison but to
clarify the results : those presenting with mesh-related pelvic pain, those with urinary
extrusion, those with vaginal exposure, and those without any of these complications.

A total of 23 patients were included in the analysis ; six had undergone more than one
previous POP surgery (26.1%). Sacrocolpopexy or anterior transvaginal mesh had been performed in 56.5% of cases, rectopexy in 4.3%, and both in 39.1%. Two patients had no recurrent or residual prolapse prior to removal.

The median operative time was 180 minutes, with a median length of hospital stay of 3 days. In 60% of cases, a concomitant procedure was performed to prevent POP reccurence (47% autologous fascia sacrocolpopexy, 4.3% utero-sacral ligaments plication, 21.7% pre-rectal fascia plication).
There were 3 cases of intraoperative bladder injury (13%). Complete mesh removal was achieved in 100% of the cases when planned but was intentionally partial in 22% of the cases (urinary extrusion in the absence of obvious prosthesis infection, patients who declined complete removal).
Seven postoperative complications were recorded (30.4%), with only one major (Clavien grade III or higher ; 4.4%) : one patient required reoperation to evacuate an infected pelvic hematoma.
Among the 15 patients presenting with mesh-related pain, the median VAS score decreased
from 7 preoperatively to 4 at 3 months postoperatively. At 3 months, 54% reported improvement,
and 27% complete resolution ; no patients experienced worsening of the pain.
Only one patient out of those without concomitant POP repair required a secondary procedure for POP recurrence during follow-up (11.1%).
The subjective success rate (defined as PGI-I 1 or 2) at last follow-up was 100%.

Robotic pelvic organ prolapse mesh removal for mesh complication and recurrence of POP
seem appears to be feasible and safe with a limited morbidity.