Gynecologic Complications: Vaginal Mesh and Robotic Surgery

Over the next decade, the field of Gynecology will be faced with a relentless number of claims associated with complications related to synthetic mesh and robotic surgery. There is a common trend between these two areas. Even though in the hands of trained physicians both are safe and effective, the overzealous marketing of these techniques to novice gynecologists and general obstetrician and gynecologists is likely the root cause of the increase in the number of reported complications.

Synthetic Mesh: Synthetic mesh has been available since the mid-1960s. However their popularity increased in late 1990’s with the introduction of tension free vaginal tape (TVT) in Europe and subsequently the US. The concept of mid urethral, tension free vaginal tapes, revolutionized the treatment of stress urinary incontinence in the aging female population around the world. The reported 10 year success rate of 90% only added to the popularity of this approach. It was not long after the initial success of TVT, that several other device companies started marketing their own version of this device. In an effort to make the procedure even more available to gynecologists who did not have the training in performing cystoscopies to ensure safety and intactness of the bladder and urethra, companies modified the retro pubic approach of TVT with trans-obturator and eventually single incision approaches. Now physicians who were focused on the practice of obstetrics and general gynecology found it profitable to add incontinence services as well. It was not long before the same device companies decided to use the same type of mesh, in larger size in the vagina for prolapse repair. No clinical studies ever showed the advantage of mesh in treating prolapse over traditional repair. Over simplification of techniques, lead to training of a large number of physicians. This aggressive marketing resulted in a large number of unqualified physicians performing surgeries beyond their training or competence.

Robotic surgery: The DaVinci robot was first designed for cardiac cases; however it found its use mostly in urology and now in gynecology. Again, the trend in aggressive marketing is continuing with this technology. Even though the robot is an excellent technique for qualified surgeons, the pressure put on physicians (from patients, hospitals and device makers) to use the robot will undoubtedly lead to a large number of complications from bowel injury, ureteral injury to port site herniations. Again as in the case with vaginal mesh, a large number of general gynecologists will start using the robot to offer services which were not in the realm of their practice previously.