AbsorbaTack Vs. ProTack Vs. Sutures: a Biomechanical Analysis of Cervical Fixation Methods for Laparoscopic Apical Fixations in the Porcine Model

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2022 Nov 20

PMID 36404354

Authors

Ludwig Sebastian

Jansen Alina

Thangarajah Fabinshy

Ratiu Dominik

Sauerwald Axel

Hachenberg Jens

Wegmann Kilian

Rudroff Claudia

Karapanos Leonidas

Radosa Julia

Trageser Nadja

Eichler Christian

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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