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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

Histological appearance of mesh fixation sites 6 weeks postoperatively after H&E staining at 40X. W=abdominal wall muscle, M=mesh, P=peritoneal surface, N=neoperitoneum.
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Figure 2: Histological appearance of mesh fixation sites 6 weeks postoperatively after H&E staining at 40X. W=abdominal wall muscle, M=mesh, P=peritoneal surface, N=neoperitoneum.

Mentions: Both H&E and trichrome staining demonstrated that all of the experimental solder constructs were appropriately bioincorporated with no evidence of any residual solder. There was no evidence of any appreciable difference from the Parietex PCO controls. Representative histologies following H&E staining are shown in Figure 2. All of the samples exhibited a complete covering of neoperitoneum and several layers of fibroblasts with good revascularization of the material. No undue reaction occurred at the native peritoneal surface, and the mesh fibers were enveloped in a foreign body reaction with foreign body giant cells and fibrosis. The control samples appeared to be slightly more hypervascular. However, the fibrosis and foreign body reaction to the mesh material itself was the same in all instances. The tissue was oriented in a concentric layer around the mesh fibers, and the entire surface was covered with a similar linearly arranged cellular layer. These layers all stained densely for collagen. No evidence was found of damage or fibrosis of the subjacent tissue layers.


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

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

Histological appearance of mesh fixation sites 6 weeks postoperatively after H&E staining at 40X. W=abdominal wall muscle, M=mesh, P=peritoneal surface, N=neoperitoneum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Histological appearance of mesh fixation sites 6 weeks postoperatively after H&E staining at 40X. W=abdominal wall muscle, M=mesh, P=peritoneal surface, N=neoperitoneum.
Mentions: Both H&E and trichrome staining demonstrated that all of the experimental solder constructs were appropriately bioincorporated with no evidence of any residual solder. There was no evidence of any appreciable difference from the Parietex PCO controls. Representative histologies following H&E staining are shown in Figure 2. All of the samples exhibited a complete covering of neoperitoneum and several layers of fibroblasts with good revascularization of the material. No undue reaction occurred at the native peritoneal surface, and the mesh fibers were enveloped in a foreign body reaction with foreign body giant cells and fibrosis. The control samples appeared to be slightly more hypervascular. However, the fibrosis and foreign body reaction to the mesh material itself was the same in all instances. The tissue was oriented in a concentric layer around the mesh fibers, and the entire surface was covered with a similar linearly arranged cellular layer. These layers all stained densely for collagen. No evidence was found of damage or fibrosis of the subjacent tissue layers.

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