Michael Kia. Mclaren Regional Medical Center
Every year approximately 175,000 laparoscopic ventral hernia procedures are performed. There are significant benefits including shorter length of stay and significantly lower infection rates, significant post-operative pain is still an issue with the procedure. Current fixation methods include tacks, absorbable and non-absorbable, along with transfascial fixation. Typically at least two rows of tacks are used, to achieve adequate fixation, often including additional trans-fascial sutures. Some surgeons carrying out robot-assisted LVHR utilise the dexterity of the end effectors to deliver a continuous suture around the circumference of the mesh graft. This is/can be technically difficult and time consuming, but many consider suture fixation to be the gold standard. Many studies have shown that the securing mechanism for the mesh, whether by tacks or other current methods, are the cause of a significant portion of post-op pain.
There appears to be a direct correlation between the number of tacks used, or sutures placed, and the degree of postoperative pain, which can persist for months. The pain maybe due to the tension created in the abdominal wall from the tacks or stitches. This tension is created during the surgery, and can increase over time as a result of mesh shrinkage.
The ideal solution would be the ability to deliver suture fixation of mesh to the abdominal wall with the same ease as a tacking device. Sutures would be secured at a repeatable tension optimised to eliminate pulling on the abdominal wall.
The Meshlock device is a 12mm disposable single-use device for laparoscopic mesh fixation for ventral and inguinal hernias. The device is fully automatic requiring only simple trigger activation by the surgeon. The device provides suture fixation at an optimal tension with the ease of a tacking device. With a single fire mechanism, the device introduces a suture through a curved needle providing a minimum of 6 mm of depth and 10mm of length with each suture loop created. The individually placed suture loops are securely bonded automatically.
The device comes with a replaceable suture spool cartridge that can hold up to 60 individual suture loops.Each suture is identical and designed to penetrate to a specific depth and length without creating any tension in the loop. This allows for the mesh to have about 15mm of motion on the anterior abdominal wall. Internal trials show that the suture loop fixation is stronger than all current tacking devices for mesh fixation. Additional trials have shown that, at rest, the suture creates negligible tension in the tissue. Additionally, stress-over-distance studies have shown the tension-free suture loops to be superior to tacks, and transfacial stitches, in preventing tearing of the muscle tissue.
Currently the device is in prototype phase. As development continues, the focus is on continued testing and preparation of the device for commercialization. It is expected that the device will potentially be used in all procedures where tacking devices are currently used.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98912
Program Number: ETP770
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster