Sexual quality of life and postoperative deep dyspareunia after <scp>vNOTES</scp> benign adnexal procedures

Berisha, Laura; Hurni, Yannick; Simonson, Colin; Di Serio, Marcello; Lachat, Régine; Bodenmann, Pauline; Seidler, Stéphanie; Mathevet, Patrice; Huber, Daniela

doi:10.1002/ijgo.15455

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Fourth, the vNOTES surgical technique for mesh extraction is evaluated. vNOTES has been reported to have numerous advantages over traditional open surgery, including minimal invasiveness, reduced postoperative pain, and faster recovery [34][35][36][37]. Additionally, it has been shown to be beneficial in patients with a high body mass index [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it is anticipated that vNOTES, which allows for the direct visualization of problematic mesh areas through the vagina, will be a more effective approach than laparoscopic mesh removal because of the latter's limited visibility of the affected areas. vNOTES also offers a minimally invasive approach compared to traditional open surgery, reducing the risk of infection and postoperative complications [34][35][36][37]. Moreover, vNOTES, which allows direct visualization and manipulation of the mesh through the vaginal canal, may offer better access to the mesh than abdominal laparoscopic approaches.…”

Section: Discussionmentioning

confidence: 99%

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

Okui,

Okui

2024

Cureus

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Background The use of polypropylene mesh in laparoscopic sacrocolpopexy (LSC) is a common treatment for pelvic organ prolapse (POP). Despite its widespread application, postoperative complications such as mesh pain and infection sometimes necessitate the removal of the mesh. However, it remains unclear in which cases mesh removal is warranted. Our research focused on the pathological changes at the sacral fixation point of the mesh. We sought to evaluate the pathological alterations of the sacral mesh removed through an innovative approach of transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods This retrospective study included nine patients who underwent mesh removal surgery at the Yokosuka Urogynecology and Urology Clinic in 2023. Extraction surgery was performed using vNOTES with the GelPoint Access Platform (Applied Medical JAPAN HEADQUARTERS, Tokyo, Japan). Non-ablative Erbium YAG and Neodymium YAG lasers (RenovaLase, SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia) were utilized for persistent stress urinary incontinence, fecal incontinence, vaginal erosion, and bleeding after surgery. Patients were categorized based on mesh fixation conditions, including unintended mesh overlap (Group I), excessive traction (Group II), and signs of mesh aging (Group III). This categorization helped to understand the distinct pathological outcomes associated with each condition. Results Pathological findings from the mesh removed via vNOTES varied significantly across the groups. In Group I, characteristic large vacuole formation and accumulation of atypical giant cells were observed, attributed to mesh overlap. Group II presented with vacuole formation, fiber degradation, and tissue destruction as a result of excessive mesh traction. In Group III, the aging of the mesh was marked by cracks in the surrounding tissues and granuloma formation. These detailed observations provide crucial insights into the underlying causes of mesh-related pain and other complications, highlighting the complexity of bodily responses to mesh implants. Conclusion This study demonstrated the effectiveness of vNOTES for polypropylene mesh removal in patients with post-LSC complications, resulting in significant pain reduction. Pathological analysis revealed that mesh-related issues stem from the surgical techniques, mesh properties, and long-term bodily reactions. These findings provide valuable insights for improving mesh design and POP treatment strategies. Despite the technical challenges, vNOTES is recommended for mesh removal in patients with pain. Additionally, the combination of UEL, VEL, targeted laser irradiation, AEL, and Nd:YAG laser treatments showed promising results in managing post-mesh removal complications such as stress urinary incontinence, vaginal erosion, bleeding, and fecal incontinence, offering hope for improved patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Okui,

Okui

2024

Cureus

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Early surgical outcomes of 550 consecutive patients treated for benign gynecological conditions by transvaginal natural orifice transluminal endoscopic surgery

Hurni,

Simonson,

Di Serio

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionEvidence about intra‐ and postoperative complication rates related to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecological conditions is still limited. We report and analyze data from a large cohort of patients operated in a single institution during 3.5 years.Material and MethodsTo evaluate the safety and feasibility of vNOTES for benign gynecological indications, we performed a single‐center observational study reporting and analyzing perioperative outcomes of 550 consecutive patients operated between 2020 and 2024.ResultsOf the 550 included patients, 365 (66.4%) underwent a vNOTES hysterectomy, 167 (30.4%) a procedure limited to the adnexa, and 18 (3.3%) other interventions, including myomectomy, pelvic adhesiolysis, post‐hysterectomy pelvic hematoma drainage, pelvic organ prolapse repair, and appendectomy. The mean age was 49.4 ± 12.2 years, and the mean BMI was 26.2 ± 5.8 kg/m2. The total complication rate was 6.5% (36 cases), of which 2.7% (15 cases) were intraoperative complications and 4.0% (22 cases) were postoperative complications. Patients presented postoperative complications classified as Clavien–Dindo (CD) grade I in 4 cases (0.7%), grade II in 10 cases (1.8%), and grade III in 8 cases (1.5%). We observed no CD grade IV and V complications. Three patients (0.5%) were rehospitalized for postoperative complications management. The conversion rate was 1.6%, with nine cases of conversion to conventional laparoscopy and none to laparotomy.ConclusionsThe application of vNOTES appears safe and feasible for most benign gynecological surgeries. Our study focused on surgical complications and demonstrated a profile similar to those reported in previous studies.

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Sexual quality of life and postoperative deep dyspareunia after vNOTES benign adnexal procedures

Cited by 2 publications

References 23 publications

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

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

Early surgical outcomes of 550 consecutive patients treated for benign gynecological conditions by transvaginal natural orifice transluminal endoscopic surgery

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