title: Comparison of location of mesh placed transvaginally vs mesh placed abdominally at the time of sacrocolpopexy.
abstract: OBJECTIVE
  The location of mesh placed at the time of abdominal sacrocolpopexy (ASC) is hypothesized to be in the same location histologically as mesh placed via full-thickness vaginal dissection in a cadaver model.
  
  
  METHODS
  Ten fresh frozen cadavers underwent mesh placement via traditional ASC. In the same specimen, a transvaginal mesh (TVM) procedure was performed, attempting a full-thickness dissection. A block section was excised from each area including full thickness of the vagina and bladder with the intervening mesh. This was analyzed by a blinded pathologist.
  
  
  RESULTS
  All cadavers underwent successful placement of both transabdominal mesh and TVM. Of the abdominally placed meshes, 6 were located between the vagina and bladder, whereas 3 were situated within the vaginal wall, with an average depth of 0.30 mm. Five of the vaginal mesh pieces were placed between the bladder and vagina, and 4 within the vaginal wall at a depth of 0.25 mm. One specimen placed vaginally was 0.05 mm within the serosa of the bladder. One specimen could not be interpreted, despite multiple cuts.
  
  
  CONCLUSIONS
  ASC and full-thickness vaginal dissection result in histologically similar locations. Dissection for ASC may only result in the correct plane between the bladder and vagina in approximately 60 % of cases. We achieved full-thickness dissection for the transvaginal approach in 50 % of the cases, with one small penetration into the bladder serosa. Using a full-thickness dissection technique for TVM may be one way of reducing mesh exposure rates in those seen with ASC.
authors: Departments of Obstetrics and Gynecology, University of California, Irvine, 101 The City Drive South, Building 56, Suite 800, Orange, CA, 92868, USA, knoblett@uci.edu.
authors: Karen
authors: K
authors: Noblett
authors: Taylor
authors: T
authors: Brueseke
authors: Fritz
authors: F
authors: Lin
authors: Peter
authors: P
authors: Rosenblatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013526:Surgical Mesh