Sling removal has traditionally been a challenging surgery due to the impossibility in most cases of being able to remove the mesh entirely due to its rupture using the electric scalpel.
Peak PlasmaBlade™ technology uses very short pulses of energy and radiofrequency to induce electrical plasma along the outer edge of a very fine (12.5um) electrode. It is more efficient and works at lower temperatures than traditional electrosurgical technology (40-170º Vs 200-350ºC). It has been classically used for replacement of cardiac devices because it does not damage the electrodes and it produces less damage to the surrounding tissues compared to conventional electrosurgery and reduces surgical time.
We currently have the PEAK PlasmaBlade™ scalpel in our center that allows us to remove slings completely and without breaking it.

We present the clinical case of a 50-year-old woman with a previous history of stress urinary incontinence and failed TOT sling placement in other center which had to be removed at the same time. She came to our institution at 2017 when we performed a REMEEX sling placement. In March 2018, she went to the emergency room due to infection and urethral erosion, so the maximum possible suburethral mesh was removed with conventional electric scalpel and posterior urethroplasty was made. Due to a clear worsening of her stress urinary incontinence a second REMEEX placement was performed in 2019, but mesh erosion was evident one year later again. Subsequently a second sling removal was made but this time with Peak Plasmablade™ technology. 
In the lithotomy position, a urethroscopy is performed, showing eroded mesh at 3-4 hours in the mid urethra. With the help of the Hegar stems, the sling is located at the vaginal level. After an inverted U-shaped incision on the anterior vaginal wall the dissection is made until the mesh is found. This is the moment to start the dissection with PPB technology which allows us to easily separate the mesh from the surrounding tissues until we reach the edge of the mesh and cut the prolene threads. 
We repeat the urethroscopy to demonstrate the absence of erosion, but again we find the same erosion visualized at the beginning of the intervention: We conclude that the eroded mesh was the first REMEEX sling that we tried to remove unsuccessfully with the traditional electrosurgical scalpel leaving a rest which eroded again. With Peak Plasmablade technology dissection and removal of the previous REMEEX is made. Finally, we perform the last urethroscopy without evidence of eroded sling. The urethral orifice is closed. We check the absence of leakage with methylene blue. Vaginal wall closure is made. Definitive bladder catheter and vaginal packing is placed.

Vaginal packing is removed in 24 hours and discharged in 72 hours. The catheter is removed in 1 month. During 3 year of follow-up, the patient has not had any more complications and she is fully continent.

The PEAK PlasmaBlade™ technology is useful and effective in full sling excision.

Continence 12S (2024) 101644
DOI: 10.1016/j.cont.2024.101644