AbsorbaTack ™ vs. ProTack ™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model.

Autor: Sebastian L; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany. sebastian.ludwig@uk-koeln.de., Alina J; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany., Fabinshy T; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany., Dominik R; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany., Axel S; Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany., Jens H; Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany., Kilian W; Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Claudia R; Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany., Leonidas K; Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany., Julia R; Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany., Nadja T; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany., Christian E; Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.; Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2023 Mar; Vol. 307 (3), pp. 863-871. Date of Electronic Publication: 2022 Nov 20.
DOI: 10.1007/s00404-022-06827-3
Abstrakt: Purpose: Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model.
Methods: A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint.
Results: There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3.
Conclusion: The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
(© 2022. The Author(s).)
Databáze: MEDLINE
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