Minimally Invasive Vaginal Natural Orifice Transluminal Endoscopic Surgery Technique for Successful Polypropylene Mesh Removal in Pelvic Organ Prolapse: A Case Report

Abstract

In the treatment of pelvic organ prolapse, the insertion of polypropylene mesh is often necessary but can lead to subsequent complications, such as a high incidence of pain and infections, necessitating mesh removal. However, the removal of polypropylene mesh can be challenging due to the risks of postoperative complications and technical difficulties. The key to effective healing often lies in the complete removal of the mesh, but this process is associated with complications, including severe pain and potential foreign body reactions. These challenges underscore the need for less invasive and more precise removal techniques.In our clinical practice, traditional approaches, such as vaginal and open abdominal surgeries, have often been hindered by limited visibility and accessibility at the mesh fixation sites. To address these issues, our team has pioneered the development of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for mesh removal. This innovative and minimally invasive technique, performed through the vaginal route, holds particular promise for repairs within the pelvic cavity. vNOTES not only enhances surgical visibility but also reduces the invasiveness of the procedure.In this case report, we present an 85-year-old female patient, who underwent transvaginal mesh (TVM) insertion at the age of 68 years. The patient developed pain in the left buttock, left lower back, and vulvar region, necessitating the removal of TVM. The vNOTES approach significantly reduced postoperative pain and complications, enabling efficient and safe removal of the polypropylene mesh. Moreover, the pathological examination of the polypropylene mesh, which was causing hip and buttock pain, revealed the presence of poor granulation tissue, indicative of a specific pathological tissue pattern. To the best of our knowledge, this is the first detailed account of the successful application of vNOTES in mesh removal.

Pathological Insights on Polypropylene Mesh Complications From Laparoscopic Sacrocolpopexy: A Case Series

“…This study considered vNOTES to be a promising surgical method for several reasons [15][16][17][18][19]. First, in our clinical experience, there is currently no consensus regarding the most effective method for mesh removal.…”

“…Pain was assessed using a Visual Analog Scale (VAS) [13,15]. For patients with urinary incontinence, evaluations were conducted using the 1-hour pad test [13,28], the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) [13], and the Overactive Bladder Symptom Score (OABSS) [13].…”

“…Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach for addressing these challenges [15]. By employing vNOTES, surgeons gain direct access and visualization from the vagina to the sacral colpopexy site, which simplifies the mesh removal.…”

“…By employing vNOTES, surgeons gain direct access and visualization from the vagina to the sacral colpopexy site, which simplifies the mesh removal. This method enables effective extraction of problematic meshes with minimal invasiveness [15][16][17][18][19]. Utilizing this technique for mesh removal could result in shorter recovery periods and an enhanced quality of life for patients.…”

“…In cases where the uterus remained, incisions were made in the anterior and posterior vaginal fornices, completing a 360-degree loop. The GelPoint™ Access Platform (Applied Medical JAPAN HEADQUARTERS, Tokyo, Japan) [15,22], an OLYMPUS endoscopic ultrasonic coagulation cutting device SONICBEAT, and HICURA type grasping forceps (Olympus Medical Systems Corp., Tokyo, Japan) were introduced. The GelPoint™ device was inserted and, while maintaining a CO2 gas pressure of 8 mmHg [15], a standard 10 mm, 0° rigid laparoscope was inserted through the camera trocar at the 6 o'clock position, and work was performed using forceps and scissors inserted through the other two trocars.…”