New area in Laparoscopic Hernia repair:
Devices for mesh introducing, placing and deploying
Hernia (2012): 16: S71
Moshe Dudai MD FACS, Centers for Laparoscopic Surgery, Tel Aviv Israel
Background: The modern Meshes for intraperitoneal Ventral hernia repair create a barrier for bowel adhesion beside of capability of incorporation into the abdominal wall. Groin meshes become less irritating by reducing mesh weight and having bigger porosity. In spite of meshes progression and guidelines for the recommended surgical techniques the adaptation of Lap Hernias repair by the surgeon was not dramatically increased. One of the major reasons is the difficulty and challenge that an average surgeon confronts with handling and placing the mesh. Placing the mesh precisely centered to the center of the Hernia defect with appropriate overlap margin all over the defect is the crucial part of the repair and will indicate if the Hernia will recurred. Another difficulty is the long operating time consuming by the Lap mesh handling. For approaching the challenges of mesh handling by the average surgeon, enabling more surgeons adapting the Lap Hernia repair and reducing the cost of the Lap procedure, devices for mesh introducing pacing and deploying started to be developed.
Methods: To date there are three functioning devices of mesh handling for Lap Ventral Hernia repair: Echo, PolyTouch and MNS – Mesh Navigating System, only the MNS is capable for Groin repair as well.
What are the optimal requirements from a mesh handling device for any Lap Hernia repair?
1. No handlings of the mesh for reducing mesh contamination, damage and time saving – the mesh preloaded and packed with the device, ready to use.
2. Single use low cost device that will not affect the cost of the mesh.
3. Fully one hand operated device – the other hand holds the tacker, no need for assistance.
4. Smooth, safe and rapid introducing and leading the mesh to the Hernia defect area.
5. Centering and orientating the center of the mesh to the center of the defect and securing adequate overlap mesh margin all over the defect – reducing recurrences.
6. Fully deploying the mesh under control for securing the centering and the overlap margins of the mesh.
7. Holding the entire mesh fully strained for fixation even pneumo is reduced – avoiding folds and wrinkles that will reduce incorporation into the abdominal wall.
8. Smooth, safe and rapid detachment from the mesh and withdraw from the abdominal cavity.
Results & Conclusions: Evaluating and comparing the data on functioning of the 3 devices leads to the conclusion that the MNS is the one device that addresses the mentioned optimal requirements. The MNS device enable the average surgeon performing easily and precisely Lap Hernia repair, potentially reducing recurrences and the cost of the procedure by dramatically cutting on the operating time.