Abstract:

Intra-abdominal adhesions represent a major cause of postoperative morbidity, including chronic or recurrent pelvic pain and infertility in a significant percent of patients. The SprayShield™ Adhesion Barrier System (Covidien, Waltham, MA) is a next-generation sprayable adhesion barrier to prevent postoperative adhesions. Initially sprayed as a liquid, SprayShield™ solidifies within 2 seconds of contact with tissue through a polyethylene glycol (PEG) ester-Trilysine reaction to form an adherent, internal tissue barrier that protects the underlying tissues for several days after surgery. After tissue begins to heal, the adhesion barrier liquefies via hydrolysis and completely absorbs within 7 days. Safety testing has shown the product to be nongenotoxic, noncytotoxic, nonsensitizing, and nonirritating. SprayShield™ has been shown to adhere well to tissue, with the mechanism of adherence believed to be mainly due to tissue surface mechanical interlocking. In studies that compared SprayShield™ to good surgical technique, virgin hogs were randomized to receive SprayShield™ or good surgical technique (Control). Compared to Controls, SprayShield™ demonstrated a statistically significant reduction in the number of adhesions (46%, p=0.04) and in the area of adhesions (83%, p=0.012) to injured sites. With its ease of application, biocompatibility and adhesion prevention efficacy, SprayShield™ may be an effective next-generation adhesion prevention product for open and laparoscopic abdominopelvic procedures as an adjunct to good surgical technique.

Authors:

Roger Ferland, M.D., F.A.C.O.G., Clinical Associate Professor in Obstetrics and Gynecology, Brown University, Providence, RI , Patrick K. Campbell, Ph.D., President , PKC Consulting, Inc., Wayland, MA

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Abstract:

Postoperative adhesions are a serious consequence of any type of intra-abdominal surgery and can result in infertility, pain, or bowel obstruction. Unfortunately, the paradox with adhesiolysis is that surgery performed to remove adhesions often results in further adhesion formation, so the problem persists and symptoms return and complications recur. Laparoscopic surgery with adherence to microsurgical techniques such as minimal tissue handling, rigorous attention to hemostasis, and copious irrigation was initially thought to minimize adhesion formation but such hopes have not been validated by clinical studies.

Authors:

Christopher Sutton, M.A., F.R.C.O.G., Professor of Gynecological Surgery, University of Surrey, Guildford, UK, Honorary Consultant Gynecologist, Royal Surrey County Hospital, Guildford, UK, Emeritus Consultant Gynecologist, Chelsea and Westminster Hospital, London, UK, Member of the Expert Adhesions Working Party of the European Society of Gynecological Endoscopy

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Abstract:

Treatment for female stress urinary incontinence (SUI) has progressed rapidly over the past ten years in the search for less invasive methods to treat this disease. There have been over 100 procedures described in the literature to date to treat female SUI; however, only two procedures have stood the test of time and have adequate cure rates: the retropubic colposuspension (Burch, MMK) and the sling. The laparoscopic approach to minimize the Burch procedure was described in the 1990s, but the evolution of the retropubic tension-free vaginal tape sling (TVT) in the late 1990s revolutionized the treatment of female SUI. More recently, the transobturator technique (TOT) and the single-incision mini-sling have been reported in attempts to further reduce the risks of sling placement. The current chapter reviews the history of treatment of female SUI and the development of these newer, less-invasive techniques. The procedures themselves are described, the risks of mesh complications reviewed, and the literature reviewed for current data on the different approaches and procedures.

Authors:

R.D. Moore, M.D., D.O., F.A.C.O.G., F.A.C.S., Director, Advanced Pelvic Surgery, Co-Director, Urogynecology, Atlanta Urogynecology Associates, Atlanta, GA, S.R. Serels, M.D., Urology Associates of Norwalk, Norwalk, CT, G.W. Davila, M.D., Chief, Gynecology and Urogynecology, Cleveland Clinic, Weston, FL, P. Settle, P.A., Pelvic Floor Consulting Inc., Minneapolis, MN

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Abstract:

This study was conducted to report on the technique, safety, and early efficacy of a single-incision mini-sling to treat female stress urinary incontinence (SUI). Women suffering from SUI were offered a single-incision approach to place a suburethral polypropylene mesh tape in a position similar to that of a transobturator sling without passage of needles through the groin. Retrospective data was collected on 61 patients that received the new MiniArc™ single-incision sling at a single center in the United States. Patient selection and concomitant procedures were determined by the senior authors at the center, and the senior authors were the primary surgeons in all cases. Procedures were completed under general, regional, or MAC anesthesia as determined by the surgeon. Average operative time for the sling procedure alone was short and the average blood loss was 29 cc. There were no intraoperative complications. There was one postoperative adverse event secondary to urinary retention that was resolved by loosening of the sling under local anesthesia in an office setting. The overall cure rate at 12 months determined by physician and patient assessment in 58/61 patients was 91.4%. No patients suffered pain or dyspareunia secondary to the sling, and no erosions or extrusions were reported. In this initial study, the MiniArc™ single-incision sling appears to be a safe approach to treat female SUI, and the early clinical results are encouraging.

Authors:

R.D. Moore, M.D., D.O., F.A.C.O.G., F.A.C.S., Director, Advanced Pelvic Surgery, Co-Director, Urogynecology, Atlanta Urogynecology Associates, Atlanta, GA, G.K. Mitchell, M.D., F.A.C.O.G., Staff Physician, Atlanta Urogynecology Associates, Atlanta, GA, J.R. Miklos, M.D., F.A.C.O.G., F.A.C.S., Director, Urogynecology, Atlanta Urogynecology Associates, Atlanta, GA

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