F P J Den Hartog, E F Van Koten, J J Van Den Dobbelsteen, P J Tanis, M Van Der Elst, A L A Bloemendaal
{"title":"Minimally Invasive Tensiometry: A New Modality for Per-Operative Measurement of Medialization and Tension During Laparoscopic Hernia Surgery.","authors":"F P J Den Hartog, E F Van Koten, J J Van Den Dobbelsteen, P J Tanis, M Van Der Elst, A L A Bloemendaal","doi":"10.3389/jaws.2022.10850","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction required to approximate these edges. This study presents minimally invasive tensiometry (MINT), a novel technology for measuring fascial tension, as well as initial experiences and results using it. <b>Methods:</b> The MINT device was designed using rapid prototyping principles. It was designed as an add-on tool for any existing laparoscopic instrument, enabling objective assessment of abdominal wall tension by the use of a manually operated linear spring. Pre-clinical measurements of medialization at 10 and 20 N of tension during AWR were performed on fresh-frozen Post-Mortem Human Specimens (PMHS). <b>Results:</b> Three specimens were included, and a total number of 36 measurements of medialization at three different levels of the abdominal wall were performed under structured and similar circumstances. Median total medialization with 20 Newton (N) of applied tension was 25 mm (mm) cranially, 37.5 mm at the umbilicus and 27.5 mm at the caudal level. The highest rate of medialization was seen at the umbilical level (2.25 mm/N). <b>Conclusion:</b> MINT is a novel non-invasive technique, which allows surgeons to intraoperatively measure fascial tension when performing AWR. The MINT device is easy to use and reproduce. The next step is to start performing clinical measurements applying MINT during AWR.</p>","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":null,"pages":null},"PeriodicalIF":0.5000,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10831690/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Abdominal Wall and Hernia Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/jaws.2022.10850","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction required to approximate these edges. This study presents minimally invasive tensiometry (MINT), a novel technology for measuring fascial tension, as well as initial experiences and results using it. Methods: The MINT device was designed using rapid prototyping principles. It was designed as an add-on tool for any existing laparoscopic instrument, enabling objective assessment of abdominal wall tension by the use of a manually operated linear spring. Pre-clinical measurements of medialization at 10 and 20 N of tension during AWR were performed on fresh-frozen Post-Mortem Human Specimens (PMHS). Results: Three specimens were included, and a total number of 36 measurements of medialization at three different levels of the abdominal wall were performed under structured and similar circumstances. Median total medialization with 20 Newton (N) of applied tension was 25 mm (mm) cranially, 37.5 mm at the umbilicus and 27.5 mm at the caudal level. The highest rate of medialization was seen at the umbilical level (2.25 mm/N). Conclusion: MINT is a novel non-invasive technique, which allows surgeons to intraoperatively measure fascial tension when performing AWR. The MINT device is easy to use and reproduce. The next step is to start performing clinical measurements applying MINT during AWR.
背景:针对复杂腹股沟疝的微创腹壁重建(AWR)新技术不断发展。为了实现疝缺损闭合,需要逼近疝缺损的肌腱边缘。目前,外科医生无法客观测量和量化近似这些边缘所需的牵引力。本研究介绍了微创张力测量(MINT)这一测量筋膜张力的新技术,以及使用该技术的初步经验和结果。方法:MINT 设备的设计采用了快速原型设计原则。它被设计为任何现有腹腔镜仪器的附加工具,通过使用手动操作的线性弹簧来实现对腹壁张力的客观评估。在新鲜冷冻的死后人体标本(PMHS)上对 AWR 期间 10 N 和 20 N 张力下的内侧化进行了临床前测量。结果:共纳入了三个标本,在结构相似的情况下对腹壁三个不同水平的内翻进行了 36 次测量。在施加 20 牛顿(N)拉力的情况下,头顶部总内侧化的中位数为 25 毫米,脐部为 37.5 毫米,尾部为 27.5 毫米。脐部内侧化率最高(2.25 mm/N)。结论MINT 是一种新颖的无创技术,外科医生在进行 AWR 时可通过它在术中测量筋膜张力。MINT 设备易于使用和复制。下一步是开始在 AWR 期间应用 MINT 进行临床测量。