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Mesh Erosion in Robotic Sacrocolpopexy

Osmundsen, Blake C. MD, MCR*†; Clark, Amanda MD, MCR*‡; Goldsmith, Crystal MD*; Adams, Kerrie MD*; Denman, Mary Anna MD, MCR*; Edwards, Renee MD, MBA*; Gregory, William Thomas MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2012 - Volume 18 - Issue 2 - p 86–88
doi: 10.1097/SPV.0b013e318246806d
AUGS Conference Presentations
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Objective This study aimed to compare the incidence of mesh erosion after robotic sacrocolpopexy between women undergoing total and those undergoing supracervical hysterectomy (SH).

Methods This is a retrospective cohort study of women who underwent sacrocolpopexy and concomitant hysterectomy using the DaVinci surgical robot between May 2007 and December 2010 at 2 sites. Baseline data were gathered before surgery. The primary outcome was mesh erosion identified during 3 months of follow-up.

Results A total of 102 women underwent sacrocolpopexy, of whom 45 were with concomitant SH and 57 were with total hysterectomy (TH). Their mean age was 58 years, mean body mass index was 26.8 kg/m2, 98% were white, 6% smoked, and 25% were on systemic hormone replacement therapy. Mean preoperative Ba = +1.4, C = −2.2. These were not different between the 2 groups or by site. Within 3 months of surgery, mesh erosion was diagnosed in 8 women, all of whom had TH. No mesh erosions occurred in the SH group (14% vs 0%). Total hysterectomy mesh erosion rate at site 1 was 3% compared with 37% at site 2. Mesh type was the only identifiable difference between sites: self-cut polypropylene at site 1, precut polypropylene at site 2. Two women in the SH had abnormal uterine pathology: 1 endometrial adenocarcinoma and 1 focus of hyperplasia with atypia.

Conclusions No mesh erosions were associated with SH within the first 3 months. In TH, the graft material used may be a modifiable factor needing further investigation. Unexpected abnormal uterine pathologic diagnosis remains a possibility with SH. Longer-term follow-up and a randomized trial are warranted to answer these questions.

Risk for mesh erosion after hysterectomy at time of sacrocolpopexy may be modified with technique.

From the *Oregon Health & Science University, Portland, OR; †Providence Hospital; and ‡Kaiser Permanente Northwest, Portland, OR.

Reprints: Blake C. Osmundsen, MD, MCR, 5050 NE Hoyt # 255, Portland, OR 97213. E-mail: Blake.Osmundsen@Providence.org.

The authors declare that they have nothing to disclose.

No funding was obtained for this project.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins