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

Abstract

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.

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

“…Jansen et al already provided a biomechanical analysis of sacral bony fixation methods of PVDF-tapes in the porcine model and compared the pre-sacral fixation with sutures with the use of titanium tacks in two different formations. Sutures represent the significantly stronger fixation method since they endure 2.6 times more load than tacks arranged in a row and 1.7 times more load than tacks arranged in a triangle formation [ 23 ]. But so far, there has not been any further biomechanical analysis performed in this specific area and there are no data available, comparing sutures with tacks for cervical fixation of these PVDF-tapes for laparoscopic bilateral apical fixation.…”

Netzchirurgie in der Gynäkologie

“…Zum einen gelingt dies durch nichtresorbierbare Titan-Tacker, die eine schnelle Fixierung ermöglichen. Zum anderen ist eine Nahtfixation mit nichtresorbierbarem Faden denkbar, diezumindest am Tiermodell seitens der Stabilität überlegen ist [18].…”

Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future?

“…Polycarbonate has also been investigated in a number of animal studies, including as an isolate material, processed with other chemicals, and for biodegradable purposes—although this is a less appropriate option for long-term anatomical support if tissue regeneration is not successful [ 63 , 64 , 65 ]. Both polyvinyl plastics, polyvinyl fluoride, and polyvinylidene fluoride were studied and performed using ovine models and a porcine cadaver, respectively [ 66 , 67 ]. Polydimethylsiloxane, a silicone-based organic polymer, has also entered preclinical in vivo animal studies with successful outcomes compared to the standard PP mesh [ 68 ].…”