Hazards of Laparoscopic Mesh Removal

Online message from Dr. Dionysios Veronkis (slightly edited for clarity) :

Vaginal mesh is placed extra peritoneally[1] (outside the body cavity and away from bowels). Although laparoscopy is touted as minimally invasive, [it is minimally invasive in] abdominal surgery. Vaginal surgery is less invasive than both laparoscopic and robotic surgery.

Robotic surgery is laparoscopic surgery aided by a computer to help the surgeon move robotic arms [which guide instruments].

When mesh is placed vaginally and removal is attempted laparoscopically, the surgeon must place small 5mm to 12mm incisions and ports in the abdomen, [adding] the risk of injury to the bowel blood vessels during trocar insertion. The peritoneum must then be cut and the bladder and vagina or rectum and vagina must be separated [by cutting through the connecting fascia].

Bear in mind that when instruments are inserted thru the abdomen, that port creates a fulcrum and a vertical angle thru the abdominal wall limits the movement of the instruments [while they operate on the horizontally-oriented] vagina.

While all this is going on you are tipped head down pelvis up so your bowels move out of harm’s way. The surgeon is operating while standing at your side with thin 5mm to 10mm instruments pushed thru your abdomen to reach your vagina—17 to 25 inches [away].

[Your alternative is to] find a vaginal surgeon who can forgo all that and go directly thru your vagina to the mesh. Remember, mesh was placed vaginally.

The thin laparoscopic instruments were never designed for the structural stiffness of the mesh. Laparoscopic instruments were designed to be thin and delicate since bowel is always present. Due to the nonspecific delicate instruments used in laparoscopic and robotic surgery, in order to remove mesh in laparoscopic surgery, robotic energy must be used. Laparoscopic surgery uses electricity to cut tissue and stop bleeding which generates heat.

Mesh is plastic. Heat melts plastic.[2] Removals done with the use of electricity will look blackened or burned with no clear edges or ends and small blood vessels need to be cauterized.

Liberal use of energy will melt the mesh, create a thermal injury that will kill tissue days later (and may result in a hole in the rectum or the bladder) or, in order to avoid melting the mesh, more tissue will be removed [than necessary], increasing the risk of a hole or a fistula.

Mesh in both groins from a TOT and mesh under the skin and muscles from a TVT can NOT be accessed by laparoscopy. They [require] an incision.

Finally, you can do all that or have the mesh removed vaginally with sharp dissection using more durable instruments designed specifically for vaginal surgery.

– D. K. Veronikis M.D. of St Louis, MO

[1] Peritoneum: the serous membrane that lines the walls of the abdominal cavity and folds inward to enclose the viscera. Normally, it is separate from the pelvic viscera.

[2] When polypropylene melts, depending on the particular material, it releases plasticizers, stabilizers, and biocides. Most of these materials will have a very low vapor pressure, so they will probably form aerosols (white smoke) and should be taken care of with a little fresh air
Burned polypropylene (black smoke, and/or flames) can form a large number of organic compounds (oxidation and/or decomposition products) including some formaldehyde, an eye and respiratory irritant, as well as related compounds.

 

 

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Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.

If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.

Subscribe to PelvicMeshOwnersGuide.com to learn more about pelvic mesh. I’d like to hear from you if you are helped by what you read here or if you need to know more about any particular topic. Comment below or email me privately at daywriter1@gmail.com..

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2 responses to “Hazards of Laparoscopic Mesh Removal

  1. Thank you Peggy.
    My mesh (Johnson & Johnson Gynaecare GS) was placed laparoscopically.
    Would the preferred removal method be transvaginally and would you know if for the same reason this would make removal more difficult?
    Thanks again, Deanne

    • I’m not a surgeon but the normal way to get them out is to make bigger incisions and go back in the way they were inserted. I’m not sure how good removal surgeons tackle that but will explore the question.
      My bias is that no mesh belongs inside the female pelvis for any reason, ever. Frankly, I’d like to see polypropylene-based mesh banned for good.
      Oh, and was it the Gynecare PS? Peggy

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