Abstract
Purpose. Operative efficiency improvements for laparoscopic ventral hernia repair (LVHR) have focused on reducing operative time while maintaining overall repair efficacy. Our objective was to evaluate procedure time and positioning accuracy of an inflatable mesh positioning device (Echo PS Positioning System), as compared to a standard transfascial suture technique, using a porcine model of simulated LVHR. Methods. The study population consisted of seventeen general surgeons (n = 17) that performed simulated LVHR on seventeen (n = 17) female Yorkshire pigs using two implantation techniques: (1) Ventralight ST Mesh + Echo PS Positioning System (Echo PS) and (2) Ventralight ST Mesh + transfascial sutures (TSs). Procedure time and mesh centering accuracy overtop of a simulated surgical defect were evaluated. Results. Echo PS demonstrated a 38.9% reduction in the overall procedure time, as compared to TS. During mesh preparation and positioning, Echo PS demonstrated a 60.5% reduction in procedure time (P < 0.0001). Although a trend toward improved centering accuracy was observed for Echo PS (16.2%), this was not significantly different than TS. Conclusions. Echo PS demonstrated a significant reduction in overall simulated LVHR procedure time, particularly during mesh preparation/positioning. These operative time savings may translate into reduced operating room costs and improved surgeon/operating room efficiency.
Highlights
Laparoscopic ventral hernia repair (LVHR) has gained acceptance as a safe and effective alternative to open ventral hernia repair (OVHR), resulting in reduced patient complications and hospital stays [1, 2]
Seventeen surgeons participated in the study and performed a simulated LVHR on an in vivo porcine model using Ventralight ST Mesh with transfascial sutures and Ventralight ST Mesh with Echo PS Positioning System (Echo PS)
We evaluated the use of Echo PS mesh in simulated LVHR, as compared to a standard repair technique using four corner transfascial sutures for mesh positioning and initial fixation
Summary
Laparoscopic ventral hernia repair (LVHR) has gained acceptance as a safe and effective alternative to open ventral hernia repair (OVHR), resulting in reduced patient complications and hospital stays [1, 2]. Previous reports have demonstrated procedure time for LVHR to be equivalent or less than OVHR, and there has been an increasing trend towards improvement of LVHR operative efficiency by reducing procedure time/cost while maximizing the aforementioned patient benefits and overall hospital efficiency [1, 3, 4]. One approach for reduction of operative procedure costs associated with LVHR would be to reduce overall procedure time by improving procedure efficiency. A second approach employs device-based methods for improvement in operative efficiency; this type of cutting edge technology bears the significant task of demonstrating considerable improvement in operative efficiency in order to gain widespread, mainstream acceptance.
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