Selective laser vaporization of polypropylene mesh used in treatment of female stress urinary incontinence and pelvic organ prolapse: Preliminary studies using a red diode laser

Background and Objectives The most common mesh-related complication experienced by patients undergoing transvaginal polypropylene synthetic slings for stress urinary incontinence (SUI) and transvaginal pelvic organ prolapse (POP) repair with mesh is vaginal mesh erosion. More than half of the patients who experience erosion from synthetic mesh require surgical excision which is technically challenging and risks damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI and POP. Materials and Methods: A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm(2), pulse duration of 100 milliseconds, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of similar to 200-mu m-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples was performed, ex vivo. Temperature mapping of suture/mesh samples with a thermal camera was also conducted. Results: Selective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 degrees C, respectively, while direct laser irradiation of tissue alone resulted in only a 1 degrees C temperature increase. Conclusions: Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal elevation in the adjacent tissue. This technique may be useful for treatment of eroded mesh after SUI or POP procedures that require surgical revision. Lasers Surg. Med. 44: 325-329, 2012. (C) 2012 Wiley Periodicals, Inc.