Surgical Dynamometer to Simultaneously Measure the Tension Forces and the Distance between Wound Edges during the Closure of a Laparotomy

Abstract

The closure of the abdominal wall after making a laparotomy is a major challenge for surgeons, since a significant percentage of closures fail and incisional hernias rise. The suture has to withstand the forces required to close the incision, while not hindering the adequate wound healing progression. Currently, there is no surgical measuring device that could be used to determine the required closing forces, which can be very different depending on the patient. This paper presents a dynamometer to measure the tension forces to be applied while closing a surgical incision, and it simultaneously measures the distance between wound edges. It is a compass-like instrument. A mechanism between the two legs incorporates a load cell, whose signal is read by an electronic device that computes the values of the tension forces between wound edges. An angular position sensor at the pin joint between legs provides the distance between both sides of the incision. Measuring capabilities of the instrument prototype were verified at the laboratory. Thereafter, its functionality was demonstrated in experimental surgery tests. Therefore, the instrument could be very useful in clinical applications, assisting personalized surgical techniques.

Miniaturized Sensors Registering the Long-Term Course of Suture Tension In Vivo under Varying Intra-Abdominal Pressure

“…They applied the forceps in an experiment in pigs. This large, handheld transducer allows for the measurement of momentary forces and no long-term measurement [ 21 ]. In 2017, von Trotha et al published a study using the knot-trainer designed by our working group with results very similar to those described in this article and drew the same conclusions [ 22 ].…”

Measurement of Closure Forces During Abdominal Wall Closure as a New Parameter for Incisional Hernia Prevention: an Experimental Animal Study

“…Accurate and reliable measurements of the closure force were key factors for this study. So, our group developed and validated a digital dynamometer designed for this purpose [27]. It is a compass-like instrument with two articulated legs that can bring closer or move further away two sets of tines that grab the tissue allowing both sides of the incision to be pulled together in a way similar to that of the suture during closure of the laparotomy.…”

“…The closure force is one of the few variables that can be assessed and controlled intra-operatively by a surgeon, but neither a suitable device to measure this force nor studies about this parameter along a laparotomy exist. This article describes an animal experimental study that uses a new digital dynamometer designed by our team [27], to analyze the closure forces along a midline laparotomy and thus describe a new parameter that could decrease the risk of developing an incisional hernia. The study was approved by the ethics committee for animal experimentation number 61/13 of the Vall d´Hebron Research Institute (VHIR), given by the Ministry of Agriculture, Ranching, Fishing and Food of the Generalitat de Catalunya (B69900062), Barcelona, Spain.…”

Fascial Closure

“…The inflammatory phase of wound healing is initiated by the tension at the STI owing to ischemia by the loop of suture [2]. Initially, the tissues become inflamed with the accumulation of neutrophils within the wound bed.…”