Nathaniel Fried

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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.

David Burks; Sarah B Rosenbury; Michael J Kennelly; Nathaniel M Fried (Profiled Author: Nathaniel Fried)

Deparment of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
Lasers in surgery and medicine 2012;44(4):325-9.

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 ∼200-µm-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°C, respectively, while direct laser irradiation of tissue alone resulted in only a 1°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.

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