Prevention of intraoperative and mesh-associated complications after transvaginal extraperitoneal surgery for pelvic organ prolapse

Mesh implants in reconstructive surgery for pelvic organ prolapse (POP) can cause intraoperative and mesh-associated complications reducing the quality of life. The aim of the study is to reduce the incidence of intraoperative and mesh-associated complications by personalized 3D modeling, planning and intraoperative navigation. Materials and Methods. The authors conducted a prospective randomized study of 93 patients operated on using trocar and anchor mesh systems. In groups 1 (n=32) and 2 (n=30), trocar and anchor mesh systems were used, respectively, without 3D modeling. In group 3 (n=31), 3D modeling for pelvic organs, planning, and intraoperative navigation were used during anchor mesh system installation. The operative time, blood loss, peri- and postoperative complications were recorded. Treatment effectiveness was determined by achieving anatomical cure: stage POP-Q ≤1. Results. 3D modeling and surgical navigation used in group 3 allowed us to reduce the surgical trauma, blood loss, the number of hematomas, and to exclude pelvic trauma. In group 1, there was 1 case (3.1 %) of intraoperative urethra and bladder injury and ureteral tamponade. In group 2, 1 person (3.3 %) had a bladder injury. Blood loss volume in group 1 was 268.6±25.8 ml, in group 2 – 67.8±54.6 ml, in group 3 – 59.4±23.6 ml. In a 3-month pe-riod in group 1 mesh complications included: vaginal mucosa erosion in 3 (9.4 %) patients, vaginal adhesions in 1 (3.1 %) patient, mesh shrinkage in 1 (3.1 %) patient, dyspareunia and pain in 5 (15.6 %) patients. In groups 2 and 3, vaginal mucosa erosion was detected in 2 (6.7 %) and 1 (3.2 %) patient, re-spectively. Anatomical success was achieved in 91.4 % of patients. Conclusions. Preoperative 3D modeling and intraoperative navigation contribute to POP surgery, which takes into account individual topographic characteristics and reduces the number of complications.