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Laparoscopic mesh fixation using laser-assisted tissue soldering in a porcine model.

Lanzafame RJ, Soltz BA, Stadler I, Soltz R - JSLS (2009 Jul-Sep)

Bottom Line: Postoperative healing was similar to that in Control segments in all cases.Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity.Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy.

View Article: PubMed Central - PubMed

Affiliation: Rochester General Hospital Laser Center, New York, USA. ray.lanzafame@rochestergeneral.org

ABSTRACT

Background and objective: Animal studies using open surgical models indicate that collagen solder is capable of fixation of surgical meshes without interfering with tissue integration, increasing adhesions, or increasing inflammation intraperitoneally. This study describes development of instrumentation and techniques for laparoscopic herniorrhaphy using laser-assisted soldering technology.

Study design and methods: Anesthetized 20 kg to 25 kg female Yorkshire pigs underwent laparoscopy with a 3-trocar technique. Parietex TET, Parietex TEC, and Prolene mesh segments (5 x 5 cm) were embedded in 55% collagen solder. Segments were inserted by using a specially designed introducer and affixed to the peritoneum by using prototype laser devices (1.45 micro, 4.5 W continuous wave, 5-mm spot, 55 degrees C set temperature) and a custom laparoscopic handpiece (IPOM). Parietex PCO mesh was inserted and affixed using the Endo-hernia stapler (Control). Animals were recovered and underwent second-look laparoscopy at 6 weeks. Mesh sites were harvested after animals were euthanized.

Results: The mesh-solder constructs were easily inserted and affixed in an IPOM approach. Prolene mesh tended to curl at its edges as the solder was melted. Postoperative healing was similar to that in Control segments in all cases.

Discussion and conclusion: Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity. Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted.

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Related in: MedlinePlus

Schematic of the experimental design demonstrating the positioning of mesh segments and the locations of the trocars in the porcine model.
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Figure 1: Schematic of the experimental design demonstrating the positioning of mesh segments and the locations of the trocars in the porcine model.

Mentions: All animal studies were conducted in accordance with PHS guidelines and under a protocol approved by the Institutional Animal Care and Use Committee of Rochester General Hospital. A laparoscopic porcine model of intraperitoneal onlay mesh (IPOM) placement was used. Laparoscopy was accomplished using three 12-mm trocars in 24 female Yorkshire pigs weighing 20 kg to 25 kg. Anesthesia induction was carried out by using the mixture of 22 mg/kg ketamine and 1.1mg/kg acetylpromazine intramuscularly and was maintained by Fluothane inhalation. Laparoscopy was conducted with CO2 insufflation at 12mm Hg. Each animal received simulated hernia closures using the study configurations according to random position assignment (Figure 1). Segments of Parietex TET, Parietex TEC, and Prolene mesh (5 × 5 cm) were embedded in 55% collagen solder. The segments were inserted using the specially designed mesh introducer instrument and fixed to the peritoneum by using the CEE laser (1.45 µ, 4.5 W CW, 5mm spot, 55°C set temperature; or 1.533 µ, 4.8 W CW, 55°C set temperature) with the custom laparoscopic handpiece designed for this purpose. Parietex PCO mesh segments were inserted and affixed using the Endo-hernia stapler (Control). The trocar sites were closed with 0-polydioxanone sutures in the fascia, and skin incisions were closed with 0-polypropylene sutures. Each animal received ceftriaxone 50 mg/kg and Banamine 1 mg/kg IM at the conclusion of the procedure.


Laparoscopic mesh fixation using laser-assisted tissue soldering in a porcine model.

Lanzafame RJ, Soltz BA, Stadler I, Soltz R - JSLS (2009 Jul-Sep)

Schematic of the experimental design demonstrating the positioning of mesh segments and the locations of the trocars in the porcine model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3015974&req=5

Figure 1: Schematic of the experimental design demonstrating the positioning of mesh segments and the locations of the trocars in the porcine model.
Mentions: All animal studies were conducted in accordance with PHS guidelines and under a protocol approved by the Institutional Animal Care and Use Committee of Rochester General Hospital. A laparoscopic porcine model of intraperitoneal onlay mesh (IPOM) placement was used. Laparoscopy was accomplished using three 12-mm trocars in 24 female Yorkshire pigs weighing 20 kg to 25 kg. Anesthesia induction was carried out by using the mixture of 22 mg/kg ketamine and 1.1mg/kg acetylpromazine intramuscularly and was maintained by Fluothane inhalation. Laparoscopy was conducted with CO2 insufflation at 12mm Hg. Each animal received simulated hernia closures using the study configurations according to random position assignment (Figure 1). Segments of Parietex TET, Parietex TEC, and Prolene mesh (5 × 5 cm) were embedded in 55% collagen solder. The segments were inserted using the specially designed mesh introducer instrument and fixed to the peritoneum by using the CEE laser (1.45 µ, 4.5 W CW, 5mm spot, 55°C set temperature; or 1.533 µ, 4.8 W CW, 55°C set temperature) with the custom laparoscopic handpiece designed for this purpose. Parietex PCO mesh segments were inserted and affixed using the Endo-hernia stapler (Control). The trocar sites were closed with 0-polydioxanone sutures in the fascia, and skin incisions were closed with 0-polypropylene sutures. Each animal received ceftriaxone 50 mg/kg and Banamine 1 mg/kg IM at the conclusion of the procedure.

Bottom Line: Postoperative healing was similar to that in Control segments in all cases.Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity.Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy.

View Article: PubMed Central - PubMed

Affiliation: Rochester General Hospital Laser Center, New York, USA. ray.lanzafame@rochestergeneral.org

ABSTRACT

Background and objective: Animal studies using open surgical models indicate that collagen solder is capable of fixation of surgical meshes without interfering with tissue integration, increasing adhesions, or increasing inflammation intraperitoneally. This study describes development of instrumentation and techniques for laparoscopic herniorrhaphy using laser-assisted soldering technology.

Study design and methods: Anesthetized 20 kg to 25 kg female Yorkshire pigs underwent laparoscopy with a 3-trocar technique. Parietex TET, Parietex TEC, and Prolene mesh segments (5 x 5 cm) were embedded in 55% collagen solder. Segments were inserted by using a specially designed introducer and affixed to the peritoneum by using prototype laser devices (1.45 micro, 4.5 W continuous wave, 5-mm spot, 55 degrees C set temperature) and a custom laparoscopic handpiece (IPOM). Parietex PCO mesh was inserted and affixed using the Endo-hernia stapler (Control). Animals were recovered and underwent second-look laparoscopy at 6 weeks. Mesh sites were harvested after animals were euthanized.

Results: The mesh-solder constructs were easily inserted and affixed in an IPOM approach. Prolene mesh tended to curl at its edges as the solder was melted. Postoperative healing was similar to that in Control segments in all cases.

Discussion and conclusion: Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity. Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted.

Show MeSH
Related in: MedlinePlus