Suturing methods in prolapse surgery: a biomechanical analysis

Hachenberg, Jens; Sauerwald, Axel; Brunke, Hendrik; Ludwig, Sebastian; Scaal, Martin; Prescher, Andreas; Eichler, Christian

doi:10.1007/s00192-020-04609-6

Cited by 3 publications

(8 citation statements)

References 24 publications

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“…Comparing those data, there was a slight difference, but the data remain at the same order of magnitude. The same applies to the parameter displacement at failure which was 16 ± 2 mm in group 4 and 29 ± 6 mm for human tissue ( p = 0.0005) and the recorded parameter stiffness with values of 5.31 ± 0.97 mm/N for porcine tissue and 2.99 ± 0.86 mm/N for human fiber [ 18 ] ( p < 0.0001).…”

Section: Resultsmentioning

confidence: 79%

“…The second study, also conducted by Sauerwald et al [ 20 ] examined the time until functional stability in pectopexy by means of cyclic testing and detected that functional stability is achieved after 19.1 cycles of a load exposure of below 25 N. Therefore, patients do not have to fear a global fixation failure. The third biomechanical analysis found in the current literature performed by Hachenberg et al [ 18 ] is already mentioned above. This study, performed on human cadaver pelvices, showed that an orthogonally placed suture is superior to an in-line suture at the sacrospinal ligament.…”

Section: Discussionmentioning

confidence: 86%

“…All trials in group 4 were limited by suture tearing. A maximum load of 89 ± 10 N could be achieved for porcine tissue, whereas Hachenberg et al [ 18 ] figured out a maximum load of 61 ± 29 N for the trials with a single suture orthogonally placed to the human anterior longitudinal ligament ( p = 0.0306). Comparing those data, there was a slight difference, but the data remain at the same order of magnitude.…”

Section: Resultsmentioning

confidence: 99%

“…Comparing those results with the data collected in group 4, the data remain at the same order of magnitude. Especially considering that Hachenberg et al [ 18 ] performed the tests on patients with the average age of 75 years, whereas the porcine cadaver pelvices are from young pigs with a tighter tissue. Therefore, the results obtained in groups 1, 2 and 3 are transferable to human sacral spines.…”

Section: Discussionmentioning

confidence: 99%

“…The first three groups evaluated and compared the different fixation devices used with the PVDF-tape, whereas the fourth group was a reference group to compare single sutures on porcine tissue with those on human tissue. In a previous work Hachenberg et al evaluated a single suture orthogonally placed to the human anterior longitudinal ligament and captured data for the biomechanical parameters displacement at failure (mm), maximum load (N) and stiffness (N/mm) [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

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Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

Jansen

Ludwig

Malter

et al. 2021

Arch Gynecol Obstet

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Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.

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Section: Resultsmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

Jansen

Ludwig

Malter

et al. 2021

Arch Gynecol Obstet

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

Ludwig

Alina

Thangarajah

et al. 2022

Arch Gynecol Obstet

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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.

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Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system

Lallemant,

Shimojyo,

Mayeur

et al. 2024

PLoS ONE

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Introduction and hypothesis In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient’s pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). Methods Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix’s or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. Results Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. Conclusion According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. Trial registration ClinicalTrials.gov Identifier: NCT04551859.

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Suturing methods in prolapse surgery: a biomechanical analysis

Cited by 3 publications

References 24 publications

Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

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

Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system

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