Human Abdominal Wall Research Articles

Morphology and arterial supply of the pyramidalis muscle in an Australian female population using computed tomography angiography

IntroductionThe structure and function of the human anterolateral abdominal wall have been thoroughly described. However, there has been limited anatomical study of the pyramidalis muscle and its arterial supply. The aim of this study was to analyse the patterns of arterial supply to the pyramidalis in a female population.MethodsA retrospective study of 32 computed tomography angiography scans of the abdominal wall of adult women was performed to assess the prevalence (bilateral or unilateral presence, or absence), morphology (medial border height, base width and thickness) of pyramidalis and patterns of arterial supply.ResultsPyramidalis prevalence was bilateral in 75% of computed tomography angiography studies (24/32), unilateral in 6.3% (2/32) and absent in 18.8% (6/32). Of the five patterns of pyramidalis arterial supply observed and described in detail, the most frequent (68%, 34/50 of cases) originated from an exclusive muscular branch of the inferior epigastric artery. Origin from the pubic branch of the inferior epigastric artery was seen in 4% (2/50). There was a single case (2%, 1/50) of artery origin from a variant obturator artery, a common trunk with the pubic branch from the inferior epigastric artery, and from the muscular branch to rectus abdominis. The artery could not be defined in 22% (11/50).ConclusionIn this computed tomography angiography study of women, five patterns of Pyramidalis arterial supply were identified. In the majority of cases, the pyramidalis derived its arterial supply from an exclusive, isolated muscular branch of the inferior epigastric artery.

Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour

The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.

Developing and validating an implantable suture tension sensor

IntroductionSuture tension has a direct influence on the sutured tissue. For abdominal wall closure, suture tension should be optimal without causing tissue necrosis, which can result in surgical site infection or incisional hernia. The purpose of the present study is to evaluate a device that can measure suture tension in-situ and in real-time. Materials and methodsA cheap, commercially available analog-to-digital converter was used, in conjunction with a force sensing resistor. A sensor probe housing was designed and 3D-printed. In order to test the sensor, a mechanical, computer controlled human abdominal wall model called the AbdoMAN was used. ResultsAn implantable suture tension sensor was developed, keeping cost-effectiveness in mind. This sensor can translate tension in the suture into a downward force, applied to the force sensing resistor. The sensor's raw readout was characterized using a set of weights, from which a formula correlating the readout to a specific force, was derived. Preliminary validation was successfully performed using the AbdoMANmodel, which showed a progressive rise in suture tension when the intra-abdominal pressure was artificially increased over time. ConclusionThe implantable suture tension sensor appeared to be capable of recording real time changes in suture tension, and the. validation process of this sensor has been initiated. With the information from devices like this, a much better understanding of the issues at play in the development of incisional hernia can be gained.

Preventing Bacterial Contamination of Breast Implants Using Infection Mitigation Techniques: An In Vitro Study.

Bacterial contamination of implants has been linked to biofilm formation and subsequent infection, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Reducing contamination during implant insertion should therefore reduce biofilm formation disease sequelae. The aim of this study was to compare levels of contamination between preventative techniques. A model to simulate the passage of implants through a skin incision was designed that utilized a sterile textured polyvinyl plastic sheet contaminated with Staphylococcus epidermidis. In the first stage of the polyvinyl contamination model, implants were subject to infection-mitigation techniques and passed through the incision, then placed onto horse blood agar plates and incubated for 24 hours. In the second stage of the study the same contamination was applied to human abdominal wall specimens. A 5 cm incision was made through skin and fat, then implants were passed through and levels of contamination were measured as described. Smooth implants grew a mean of 95 colony-forming units (CFUs; approximately 1 CFU/cm2) and textured implants grew 86 CFUs (also approximately 1 CFU/cm2). CFU counts were analyzed by the Mann-Whitney U-test which showed no significant difference between implant types (P < .05); independent-sample t-tests showed a significant difference. The dependent-variable techniques were then compared as groups by one-way analysis of variance, which also showed a significant reduction compared with the control group (P < .01). This in vitro study has shown the effectiveness of antiseptic rinse and skin/implant barrier techniques for reducing bacterial contamination of breast implants at the time of insertion.

Mechanical Characterization of the Human Abdominal Wall Using Uniaxial Tensile Testing.

It is generally accepted that the human abdominal wall comprises skin, subcutaneous tissues, muscles and their aponeuroses, and the parietal peritoneum. Understanding these layers and their mechanical properties provides valuable information to those designing procedural skills trainers, supporting surgical procedures (hernia repair), and engineering-based work (in silico simulation). However, there is little literature available on the mechanical properties of the abdominal wall in layers or as a composite in the context of designing a procedural skills trainer. This work characterizes the tensile properties of the human abdominal wall by layer and as a partial composite. Tissues were collected from fresh-never-frozen and fresh-frozen cadavers and tested in uniaxial tension at a rate of 5 mm/min until failure. Stress-strain curves were created for each sample, and the values for elastic moduli, ultimate tensile strength, and strain at failure were obtained. The experimental outcomes from this study demonstrated variations in tensile properties within and between tissues. The data also suggest that the tensile properties of composite abdominal walls are not additive. Ultimately, this body of work contributes to a deeper comprehension of these mechanical properties and will serve to enhance patient care, refine surgical interventions, and assist with more sophisticated engineering solutions.

Full-field in vivo experimental study of the strains of a breathing human abdominal wall with intra-abdominal pressure variation

The presented study aims to assess the mechanical behaviour of the anterior abdominal wall based on an in vivo experiment on humans. Full-field measurement of abdominal wall displacement during changes of intra-abdominal pressure is performed using a digital image correlation (DIC) system. Continuous measurement in time enables the observation of changes in the strain field during breathing. The understanding of the mechanical behaviour of a living human abdominal wall is important for the proper design of surgical meshes used for ventral hernia repair, which was also a motivation for the research presented below.The research refers to the strain field of a loaded abdominal wall and presents the evolution of principal strains and their directions in the case of 12 subjects, 8 male and 4 female. Peritoneal dialysis procedure allows for the measurement of intra-abdominal pressure after fluid introduction.High variability among patients is observed, also in terms of principal strain direction. Subjects exhibit intra-abdominal pressure of values from 11 to 21 cmH2O. However, the strain values are not strongly correlated with the pressure value, indicating variability of material properties.

Hernia Mesh with Biomechanical and Mesh–Tissue Interface Dual Compliance for Scarless Abdominal Wall Reconstruction

AbstractA fabric hydrogel composite hernia mesh with biomechanical and mesh–tissue interface dual compliance is designed for scarless abdominal wall reconstruction. The mesh is composed of a polyester knitted fabric and chitosan–polyacrylamide hydrogel complex. The mechanical properties of the composite mesh are adjusted to resemble the human abdominal wall by alkali treatment of chitosan to achieve good biomechanical compliance. An adhesion group is introduced into the composite mesh that forms covalent bonds with tissue, eliminating the need for suturing, reducing stress concentration at the fixation site, achieving mesh‐tissue interface compliance, and improving the simplicity of the operation. Covalent bonds and hydrogen bonds make the mesh have strong adhesion (70.1 ± 3.2 kPa) and repeatable (four times) robust adhesiveness. In vivo experiments using a rabbit abdominal wall defect model demonstrate quick adhesiveness and excellent functional reconstruction. Biomechanical and mesh–tissue interface dual compliance allow the tissue to regenerate an intact abdominal wall structure. The adhesive fabric hydrogel composite hernia mesh offers significant clinical values for repairing abdominal wall defects and provides design ideas for repairing other load‐bearing soft tissues.

(109) Transdermally Powered, MRI Conditional Pump-in-Reservoir Implant Inflator System: Preclinical Studies

Abstract Introduction Inflatable medical implants have been used in the treatment of erectile dysfunction and both urinary and fecal incontinence. However, commercially available devices have required manual operation, which present difficulty in their use for patients lacking strength and dexterity to use such pumps. In women with urinary incontinence, anatomical constraints limit the use of manually operable inflatable devices. Objective The aim of this study was to conduct preclinical testing of a wirelessly powered inflatable medical implant system consisting of a medical provider software application, a patient external controller, and a magnetic resonance imaging (MRI)-conditional nonferrous pump-in-reservoir implant system. Methods An inflatable medical implant system was designed and tested. Serial prototypes designs included a nonferrous, reservoir-submerged package containing electronic motor and pump with piezoelectric valves, and an external controller resembling a TV remote. The implant system was evaluated after being connected to commercially available penile prosthetic cylinders. Power settings were tested at various thresholds; testing requirements considered to be clinically applicable were set as fluid transfer of 60 ml of normal saline at 25 psi within 45 seconds. The effectiveness of power transmission across the human abdominal wall was tested using an interface of a steak slab placed between the external controller and the implant system. Results Device testing at 24 and 36 volts determined that the latter was more efficient and afforded a smaller motor and pump package. Full penile cylinder inflation was recorded at 23 seconds. Effective power transmission was demonstrated across steak slabs. Conclusions A nonferrous pump-in-reservoir medical implant inflator system for penile prostheses is legitimate. It offers an improvement over manually operated inflatable devices, and because it eliminates a manual pump component there is feasibility of constructing a modified device for fluid transfer of urethral cuffs for treating urinary incontinence in men and women. The pump package within the reservoir is advantageous as a heatsinking feature that may limit implant overheating. Finally, the device design without ferrous components affords MRI compatibility. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Novartis

Preoperative planning of three axis intersection surgical laparoscopic arm system based on characteristic parameters.

The application of robotics in the field of minimally invasive surgery solves some shortcomings of traditional minimally invasive surgery. Preoperative planning is an important prerequisite for the successful completion of robot-assisted surgery. The optimization of surgical incision position and the initial location of surgical robot are two important parts of preoperative planning. In this paper, a novel structure and preoperative planning method of a three-axis intersection surgical manipulator are proposed. Firstly, a mathematical model of human abdominal wall was established. Three characteristic parameters between the lesion and the incision are defined and used to optimize the surgical incisions. Then, the spatial position relationship between the laparoscopic arm and the incision was analyzed to obtain the effective solution groups of each passive joint of the laparoscopic arm. Lastly, the optimal initial location of the laparoscopic arm was determined by taking the total joint variables of the telecentric mechanism as the optimization index. According to a given set of lesion parameters and the position of laparoscopic arm base, the optimal incision position was obtained using the surgical incision characteristic parameters and the optimal triangle criterion, and the positioning angles of the laparoscopic arm were optimized by using the Total Joint Variable (TJV) as the evaluation index. The proposed preoperative planning method is verified by simulation. The proposed method can realize the preoperative planning process of the three axis intersection laparoscopic arm. The proposed method of preoperative planning will provide important reference to improve the intelligence of robot-assisted surgery.

A Systematic Review of Fibonacci Sequence in the Human Abdominal Wall: Facts and Reality.

The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the sum of the two preceding ones. The ratio of two consecutive Fibonacci numbers, also called the golden proportion, approximately equals1.618. We analyzed the existence of Fibonacci numbers and golden ratios in the field of hernia and abdominal wall reconstruction. We found substantial evidence of the use of the golden ratio in siting of the umbilicus. The Fibonacci numbers also showed up frequently in the anatomy of the abdominal wall. However, this was not as appropriate as the other instances in the human body or in nature.

Preparation and Biocompatibility Study of Contrast-Enhanced Hernia Mesh Material.

Meshes play a crucial role in hernia repair. However, the displacement of mesh inevitably leads to various associated complications. This process is difficult to be traced by conventional imaging means. The purpose of this study is to create a contrast-enhanced material with high-density property that can be detected by computed tomography (CT). The contrast-enhanced monofilament was manufactured from barium sulfate nanoparticles and medical polypropylene (PP/Ba). To characterize the composite, stress tensile tests and scanning electron microscopy (SEM) was performed. Toxicity and biocompatibility of PP/Ba materials was verified by in vitro cellular assays. Meanwhile, the inflammatory response was tested by protein adsorption assay. In addition, an animal model was established to demonstrate the long-term radiographic effect of the composite material in vivo. Subsequent pathological tests confirmed its in vivo compatibility. The SEM revealed that the main component of the monofilament is carbon. In vitro cell experiments demonstrated that novel material does not affect cell activity and proliferation. Protein adsorption assays indicated that the contrast-enhanced material does not cause additional inflammatory responses. In addition, in vivo experiments illustrated that PP/Ba mesh can be detected by CT and has good in vivo compatibility. These results highlight the excellent biocompatibility of the contrast-enhanced material, which is suitable for human abdominal wall tissue engineering.

Characteristic distribution of eicosapentaenoic acid in human abdominal aortic aneurysm wall

Abdominal aortic aneurysm (AAA) is a vascular disease in which the abdominal aorta gradually dilates. Dilation of AAA is associated with the aortic wall weakness induced by chronic inflammation (1). Several epidemiologic studies reported that consumption of fish is associated with the prevention of AAA. Animal and human studies suggested n-3 PUFAs can protect against AAA development and rupture. These previous data provide evidence to suggest the suppressive effect of n-3 PUFAs on AAA, which has no pharmaceuticals; however, the distribution of n-3 PUFAs in the aorta is a “missing link” to understand mechanisms underlying suppressive effects of them.

P024 BIOMECHANICAL INFLUENCES TO BE CONSIDERED FOR A DURABLE INCISIONAL HERNIA REPAIR

Abstract Aim Recurrence indicates a failed repair. Which biomechanical factors have to be considered to reduce failure rates? How can surgeons enhance the interface between mesh and tissue? Material and Methods The strength of the mesh-tissue interface was evaluated by cyclic loading. A self-made bench test was used to apply dynamic intermittent strain (DIS) to model preparations in order to evaluate the tissue quality and the material properties of hernia meshes and fixation devices. The influences and the properties were condensed in coefficients representing their relative strengths. The strain of the individual human abdominal wall were determined with computerized tomography at rest and during Valsalva’s maneuver. Results The strain observed in porcine, bovine and human tissue was in the same range. Tissue samples exhibited both brittle and ductile failure patterns. Both the load duration and the peak load increased destruction. Stress concentration elevated failure rates. Regional areas of distorsions increase stress concentrations. Hernia repair has to counteract individual strain levels. Measures to improve hernia repair include closure of the defect, use of higher DIS class meshes, increased mesh overlap and additional fixation. In the clinical routine, all measures must be adapted to the individual tissue quality. Conclusions Using the conception of GRIP as the gained resistance towards pressure related impacts, a durable hernia repair can be designed from coefficients determined with a bench test or with computerized tomography of the human abdominal wall. Pain levels and hernia recurrence rates can be reduced in incisional hernia repair when biomechanical principles are considered.

Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair.

Aim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue.Material and Methods: This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery.Results: The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired.Conclusion: The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair.

A novel in vivo approach to assess strains of the human abdominal wall under known intraabdominal pressure

The study concerns mechanical behaviour of a living human abdominal wall. A better mechanical understanding of a human abdominal wall and recognition of its material properties is required to find mechanically compatible surgical meshes to significantly improve the treatment of ventral hernias.A non-invasive methodology, based on in vivo optical measurements is proposed to determine strains of abdominal wall corresponding to a known intraabdominal pressure. The measurement is performed in the course of a standard procedure of peritoneal dialysis. A dedicated experimental stand is designed for the experiment. The photogrammetric technique is employed to recover the three-dimensional surface geometry of the anterior abdominal wall at the initial and terminal instants of the dialysis. This corresponds to two deformation states, before and after filling the abdominal cavity with dialysis fluid.The study provides information on strain fields of living human abdominal wall. The inquiry is aimed at principal strains and their directions, observed at the level from -10% to 17%. The intraabdominal pressure related to the amount of introduced dialysis fluid measured within the medical procedure covers the range 11–18.5 cmH2O.The methodology leads to the deformation state of the abdominal wall according to the corresponding loading conditions. Therefore, the study is a step towards an identification of mechanical properties of living human abdominal wall.

Laparoscopic specimen extraction in vitro: preliminary experience

BackgroundThe last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible. This experiment aimed to explore the maximum diameter of specimens that can be extracted through auxiliary incisions of different lengths and shapes by in vitro physical experiments.Materials and methodsWe used the abdominal wall with the muscle layer, fixed on a square wooden frame, to simulate the human abdominal wall. Then, specimen extraction ports were made with circular, inverted Y-shaped and straight-line incisions of different sizes and lengths, and specimens of different sizes were made from tissues of different species. These specimens were extracted from different incisions with a force gauge. The tension value (N) was measured, and records were made of the length or diameter of the smallest auxiliary incision through which a given specimen could pass, as well as the largest specimen diameter that could pass through an incision of a given size. This experiment provides us with preliminary experience-based knowledge of how to choose the appropriate auxiliary incision for surgical specimen extraction according to the diameter of the specimen.ResultsThe maximum diameters of specimens that could be extracted with circular ostomy diameters of 2.4, 2.7 and 3.3 cm were 4.0, 4.5 and 6.0 cm, respectively. Specimens with diameters of 6.0, 8.0 and 10.0 cm could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 1 cm and an extension length of 1.0, 3.0, and 4.0 cm, respectively. Moreover, these same specimens could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 2 cm and extension lengths of 0.0, 1.0 and 2.0 cm. Tough tissue specimens (made from chicken gizzards) with diameters of 1.0, 2.0, 4.0 and 6.0 cm, respectively, could be removed through straight-line incisions measuring 1.0, 2.0, 3.0 and 4.0 cm in length.ConclusionAlong with preoperative imaging, surgical planning and trocar position, the shape and length of auxiliary incisions can be used to improve the extraction of specimens via laparoscopic surgery.

Оцінка просторового розподілу механічних властивостей тканин передньої черевної стінки за даними характеру їх деформування при максимальних функціональних навантаженнях

The purpose of the study was to investigate the changes in the mechanical properties of the anterior abdominal wall at maximum functional loads. Materials and methods. The study was conducted on 112 volunteers aged 18 to 49 years old who were examined and treated in the surgical department of the Medical Diagnostic and Treatment Center "Medion" Poltava for the period from June 2020 to May 2021. There were 60 women (53.6 %), and 52 (46.4%) men. Volunteers were divided into 2 groups: the main group (n=58), which underwent the analysis of movement and deformation changes of the anterior abdominal wall during maximal abdominal inflation during the examination, and the control group (n=54), which were operated laparoscopically due to the schedule. Results and discussion. The results of the study showed the following changes in the mechanical properties of the tissues of the anterior abdominal wall: the average deformation in the longitudinal direction was 6% in the main group and 12% in the control one; deformations in the transverse direction were 3% in the main group and 8% in the control group; deformation in the longitudinal direction exceeded the deformation in the transverse by 38-54% (on average by 46%); the area of the anterior abdominal wall in the main group increased by 10%, and in the control one – by 22% (on average by 16%). During the studies, the anterior abdominal wall underwent greater stresses in the transverse orientation than in the longitudinal one (anisotropy coefficient ~2). The Young's modulus of anterior abdominal wall in the sagittal plane is defined as 23.5±2.6 kPa, while in the transverse – 42.5±7.0 kPa. The mechanical properties of human anterior abdominal wall tissues differed along and across the white line of the abdomen: the modulus of elasticity of anterior abdominal wall tissues, with the same force of impact, in the longitudinal direction is less than the transverse average of 44% (p &gt;0.05). That is, the longitudinal stiffness of the anterior abdominal wall is lower than the transverse one. The maximum strength of the anterior abdominal wall is across the white line of the abdomen, and the greatest elasticity – along. The anterior abdominal wall in women showed increased elasticity compared to men, while the stiffness of the anterior abdominal wall tissue in men in both directions was statistically significantly higher than in women (p &gt;0.05). Conclusion. Reconstruction of the spatial distribution of the mechanical properties of anterior abdominal wall tissues according to the nature of their deformation at maximum functional loads provides an additional opportunity to assess the biomechanics of anterior abdominal wall. The mechanical properties of the musculo-aponeurotic structures of anterior abdominal wall in humans differ in the longitudinal and transverse directions. They have the greatest elasticity in the longitudinal direction, and the maximum rigidity and strength in the transverse direction. The strength of the anterior abdominal wall tissue in men is higher, and the elasticity is less than in women. Changes in the mechanical anisotropic characteristics of anterior abdominal wall tissues at maximum functional loads should be taken into account when performing the anterior abdominal wall alloplasty technique

A Polymer-Biologic Hybrid Hernia Construct: Review of Data and Early Experiences.

Surgical mesh reinforcement of the human abdominal wall has been found to reduce the chance of recurrence in hernia repairs. While traditionally polymer meshes have been used in hernia repair, alternative mesh options have been engineered to prevent the inflammatory foreign body response invoked by polymers. A reinforced tissue matrix (RTM) mesh has been developed by embedding a polymer within a decellularized extracellular matrix. This combination has been attributed to the recruitment of host cells, a pro-healing response, and attenuation of the foreign body response. This has been observed to lead to the regeneration of functional tissue within the repair site that is reinforced by the polymer to offload abdominal pressures over time. This manuscript presents the review of OviTex, an RTM, in several types of hernia repair. The authors have found that the use of RTM in hernia repair is effective in preventing foreign body response, promoting wound healing, and providing reinforcement to lower the risk of hernia recurrence.

In vivo performance of intraperitoneal onlay mesh after ventral hernia repair

BackgroundVentral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. MethodsThis analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. FindingsThe relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. InterpretationThe physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.

1008-P: 3D Acoustic Radiation Force Impulse Virtual Imaging of Whole Human Abdominal Subcutaneous Tissue Imaging with “Insulin Ball”

Introduction: Current evidence suggests that subcutaneous “insulin ball”, a feature of the tissue-dystrophy, provokes hormonal perturbation in insulin absorption. Unforeseen 3-dimension (3D) whole human abdominal subcutaneous tissue within the insulin injecting subjects, we tried to elucidate a novel 3D ultrasound acoustic radiation force impulse (3D-ARFI) to quantitates the entire “tissue-dystrophy” volume in human. Methods: Seven patients with daily insulin injected diabetes were enrolled and the 3D-ARFI was applied to measure tissue displacement. To generate the elasticity gradients along the depth axis of the whole abdominal subcutaneous tissue, we compared lateral region of the abdomen as internal-control. A subcutaneous insulin tolerance test was conducted to validate the rate of insulin absorption at the site of the tissue-dystrophyand control. We also analyzed the volume of whole insulin induced tissue-dystrophy with entire abdominal wall volume governed by consecutive ARFI slice imaging. Results: Subcutaneous tissue stiffness measured by ARFI revealed that ARFI enabled the elastic characterization (p&amp;lt;.01). The 3D-ARFI demonstrated the differentiated elastic layers in the 3D model of entire human abdominal wall, and calculatedthe 3D volume of the tissue-dystrophy from entire abdominal subcutaneous volume (2.59±1.20%). The serum concentration area-under the curve (0-240min) after the 0.1U/kg IAsp injection was 33% lower at the tissue-dystrophylesions compared to the control lesion (p&amp;lt;.05). Conclusion: We present the first example of virtual touch quantification imaging with the 3D-ARFI of human abdominal subcutaneous tissue, focusing on insulin injected diabetes and demonstrate its application for the biomedical 3D structure. Disclosure G. Sato: None. H. Uchino: None. Y. Shimizu: None. K. Ishii: None. A. Ishiko: None. T. Morita: None. N. Kumashiro: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. T. Hirose: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd. Funding Japan Society for the Promotion of Science (17K01425)