Lanzafame Raymond J, Soltz Barbara A, Stadler Istvan, Soltz Robert
Rochester General Hospital Laser Center, New York, USA.
JSLS. 2009 Jul-Sep;13(3):293-301.
Animal studies using open surgical models indicate that collagen solder is capable of fixation of surgical meshes without interfering with tissue integration, increasing adhesions, or increasing inflammation intraperitoneally. This study describes development of instrumentation and techniques for laparoscopic herniorrhaphy using laser-assisted soldering technology.
Anesthetized 20 kg to 25 kg female Yorkshire pigs underwent laparoscopy with a 3-trocar technique. Parietex TET, Parietex TEC, and Prolene mesh segments (5 x 5 cm) were embedded in 55% collagen solder. Segments were inserted by using a specially designed introducer and affixed to the peritoneum by using prototype laser devices (1.45 micro, 4.5 W continuous wave, 5-mm spot, 55 degrees C set temperature) and a custom laparoscopic handpiece (IPOM). Parietex PCO mesh was inserted and affixed using the Endo-hernia stapler (Control). Animals were recovered and underwent second-look laparoscopy at 6 weeks. Mesh sites were harvested after animals were euthanized.
The mesh-solder constructs were easily inserted and affixed in an IPOM approach. Prolene mesh tended to curl at its edges as the solder was melted. Postoperative healing was similar to that in Control segments in all cases.
Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity. Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted.
使用开放手术模型的动物研究表明，胶原蛋白焊料能够固定手术补片，且不会干扰组织整合、增加粘连或加剧腹腔内炎症。本研究描述了使用激光辅助焊接技术进行腹腔镜疝修补术的器械和技术的开发。
对体重20至25千克的雌性约克夏猪进行麻醉，采用三套管技术进行腹腔镜检查。将Parietex TET、Parietex TEC和普理灵补片段（5×5厘米）嵌入55%的胶原蛋白焊料中。使用专门设计的导入器插入补片段，并使用原型激光设备（1.45微米，4.5瓦连续波，5毫米光斑，设定温度55摄氏度）和定制的腹腔镜手持器械（腹腔内补片修补术）将其固定于腹膜。使用疝气内镜吻合器（对照）插入并固定Parietex PCO补片。动物恢复后，在6周时进行二次腹腔镜检查。动物安乐死后，采集补片部位样本。
补片-焊料结构易于通过腹腔内补片修补术方法插入并固定。随着焊料熔化，普理灵补片边缘往往会卷曲。所有病例术后愈合情况与对照部位相似。
基于胶原蛋白的组织焊接可实现正常伤口愈合，并可能减少或避免使用吻合钉或其他异物进行腹腔镜补片固定，预防组织缺血以及可能的神经卡压，而这些情况会导致严重的术后疼痛和发病率。激光辅助补片固定是腹腔镜疝修补术一种有前景的替代方法。该策略值得进一步开发。
