Name: application of a new mesh fixation method in laparoscopic incisional hernia repair
Uploaded: 2022-12-23T15:00:00
Description: Watch this Scientific Journal Video about Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair at JoVE.com

本研究得到了广东省科技计划项目（批准号：2021A1515410004）和国家临床重点学科（批准号：[2012]649）的支持。

该协议是根据《赫尔辛基宣言》的原则执行的，并经中山大学附属第六医院伦理审查委员会批准。
告知患者和家属拍摄和制作手术视频的目的，并征得知情同意。
1. 患者数据和分组
注：2018年1月至2020年6月，在中山大学附属第六医院进行胃肠道、疝气、腹部手术，采用IPOM方法进行腹腔镜切口疝修补术。在获得知情同意后?...

<ol>
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Progress. 104 (4), 368504211052354 (2021).</li><li>Zhou, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+modelized+port+arrangement+based+on+data+analysis+and+calculation+in+laparoscopic+repair+of+abdominal+wall+incisional+hernia.">Application of modelized port arrangement based on data analysis and calculation in laparoscopic repair of abdominal wall incisional hernia.</a> Chinese Journal of General Surgery. 31 (4), 449-456 (2022).</li><li>Bittner, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+of+Guidelines+for+laparoscopic+treatment+of+ventral+and+incisional+abdominal+wall+hernias+(International+Endohernia+Society+(IEHS))+-+Part+A.">Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia 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href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain,+quality+of+life+and+recovery+after+laparoscopic+ventral+hernia+repair.">Pain, quality of life and recovery after laparoscopic ventral hernia repair.</a> Hernia. 13 (1), 13-21 (2009).</li><li>Bageacu, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+repair+of+incisional+hernia:+A+retrospective+study+of+159+patients.">Laparoscopic repair of incisional hernia: A retrospective study of 159 patients.</a> Surgical Endoscopy. 16 (2), 345-348 (2002).</li><li>Taylor, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+inguinal+hernia+repair+without+mesh+fixation,+early+results+of+a+large+randomised+clinical+trial.">Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial.</a> Surgical Endoscopy. 22 (3), 757-762 (2008).</li><li>Baker, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decreased+re-operation+rate+for+recurrence+after+defect+closure+in+laparoscopic+ventral+hernia+repair+with+a+permanent+tack+fixated+mesh:+A+nationwide+cohort+study.">Decreased re-operation rate for recurrence after defect closure in laparoscopic ventral hernia repair with a permanent tack fixated mesh: A nationwide cohort study.</a> Hernia. 22 (4), 577-584 (2018).</li><li>Beldi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesh+shrinkage+and+pain+in+laparoscopic+ventral+hernia+repair:+A+randomized+clinical+trial+comparing+suture+versus+tack+mesh+fixation.">Mesh shrinkage and pain in laparoscopic ventral hernia repair: A randomized clinical trial comparing suture versus tack mesh fixation.</a> Surgical Endoscopy. 25 (3), 749-755 (2011).</li><li>Muysoms, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Randomized+clinical+trial+of+mesh+fixation+with+&amp;#34;double+crown&amp;#34;+versus+&amp;#34;sutures+and+tackers&amp;#34;+in+laparoscopic+ventral+hernia+repair.">Randomized clinical trial of mesh fixation with &amp;#34;double crown&amp;#34; versus &amp;#34;sutures and tackers&amp;#34; in laparoscopic ventral hernia repair.</a> Hernia. 17 (5), 603-612 (2013).</li><li>Eriksen, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fibrin+sealant+for+mesh+fixation+in+laparoscopic+umbilical+hernia+repair:+1-year+results+of+a+randomized+controlled+double-blinded+study.">Fibrin sealant for mesh fixation in laparoscopic umbilical hernia repair: 1-year results of a randomized controlled double-blinded study.</a> Hernia. 17 (4), 511-514 (2013).</li><li>Erwin, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesh+fixation+in+laparoscopic+incisional+hernia+repair:+Glue+fixation+provides+attachment+strength+similar+to+absorbable+tacks+but+differs+substantially+in+different+meshes.">Mesh fixation in laparoscopic incisional hernia repair: Glue fixation provides attachment strength similar to absorbable tacks but differs substantially in different meshes.</a> Journal of the American College of Surgeons. 212 (1), 80-86 (2011).</li><li>Carbonell, A., et al. <a target="_blank" 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腹腔镜切口疝修补术主要使用IPOM方法5进行，其中网片的放置和固定是获得良好结果的关键。如果网片的放置和固定不当，网片将无法紧紧粘附在腹壁上，并且可能会起皱或移位。网片固定不当与血清肿形成、腹部感染、慢性疼痛和疝气复发有关。具体来说，网状感染的治疗包括穿刺和引流。与网片感染相关的术后疼痛通常保守治疗，治疗不良可能需要进一步手术切除部分或全?...

切口疝是腹部手术后常见的并发症，只能通过手术进行适当治疗1.与传统的开切口疝相比，腹腔镜疝具有手术创伤少、感染率低、术后恢复快等优点2，3。目前，如果没有禁忌症，腹腔镜疝气是治疗切口疝的首选方法4。
然而，腹腔镜疝在技术上很复杂。腹腔内嵌网（IPOM）通常用于腹腔镜切口疝修补术，这涉及在腹腔镜下将网片放入腹腔以覆盖疝气缺损5。该网片是一种新型的中等重量单丝聚丙烯网，内脏侧覆盖有水凝胶屏障6。对于使用IPOM方法的腹腔镜切口疝修补术，需要掌握穿刺器的放置，分离腹内粘连的技术，缝合切口疝的技术以及将网片放置在腹腔中的方法。特别是，如果网状物没有正确放置和固定，这可能导致疝气复发，以及潜在的严重并发症，例如肠梗阻和网片感染7，8。因此，掌握正确的网片固定技术是取得良好手术效果的重要标准。 
切口疝的传统网片固定方法是用双环疝气钉固定网片。将网片放入腹腔后，先用射钉枪固定网片边缘，再固定疝环边缘9.但该方法空间定位较差，网片易发生位移，导致疝气复发。通过对各种网片固定方法的回顾和分析，提出一种新的“对位和对齐”的网片固定方法，并在本协议10中提出。在这种方法中，预先测量切口疝的大小和范围，然后可以预先标记网状固定点。当在手术过程中将网片放入腹腔时，可以根据先前标记的位置进行钉枪固定和缝合固定。这种方法可以降低手术难度、手术时间、医疗费用和并发症的发生。本研究将这种新方法与传统使用的双环疝气钉固定方法进行比较，用于腹腔镜切口疝修补手术中的网状固定。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1-0 Stratafix Symmetric PDS Plus Violet 45cm PS-1&#160;</td>
			<td>ETHICON</td>
			<td>sxpp1a401</td>
			<td>STRATAFIX Symmetric PDS Plus</td>
		</tr>
		<tr>
			<td>3-0 VICRYL suture</td>
			<td>ETHICON</td>
			<td>VCP316</td>
			<td>absorbable suture</td>
		</tr>
		<tr>
			<td>AbsorbaTack Fixation</td>
			<td>Covidien llc</td>
			<td>ABSTACK15</td>
			<td>absorbable nail gun</td>
		</tr>
		<tr>
			<td>Laparoscopic needle holder</td>
			<td>KARL-STORZ</td>
			<td>26173KL</td>
			<td>needle holder</td>
		</tr>
		<tr>
			<td>Laparoscopic separating forceps</td>
			<td>KARL-STORZ</td>
			<td>38651ON</td>
			<td>separating forceps</td>
		</tr>
		<tr>
			<td>Laparoscopic system (OTV-S400)</td>
			<td>Olympus</td>
			<td>CLV-S400_WA4KL530</td>
			<td>4K HD image large screen surgical laparoscope</td>
		</tr>
		<tr>
			<td>ProTack Fixation</td>
			<td>Covidien llc</td>
			<td>174005</td>
			<td>Non absorbable nail gun</td>
		</tr>
		<tr>
			<td>VENTRALIGHT ST</td>
			<td>BARD</td>
			<td>5954810</td>
			<td>Biological anti-adhesion mesh</td>
		</tr>
	</tbody>
</table>

application of a new mesh fixation method in laparoscopic incisional hernia repair

使用腹腔内嵌体网片（IPOM）的腹腔镜切口疝修补术是修复切口疝气最广泛使用的微创方法之一。腹腔镜IPOM涉及通过腹腔镜将网片植入腹腔以修复腹壁疝。在IPOM手术中，在闭合疝环后，在腹腔镜下放置抗粘连网。该网片的正确放置对于该方法的成功至关重要，并且需要手术技能才能实现完美放置。如果网片放置不当，手术和麻醉时间就会延长。此外，网片放置不当会导致严重后果，如肠梗阻和网片感染。该文描述了一种“对位对齐”的网片固定方法，该方法涉及预先标记网片的固定位置以降低网片放置的难度。正确放置的网片在腹膜上完全平坦，边缘不卷曲或缠绕，并且网片牢固地粘附，以便在去除气腹压力后不会移位。与其他技术相比，“对位和对准”网片固定技术具有网片放置可靠、并发症更少的优点，并且易于学习和掌握。它还允许根据切口疝气的解剖结构提前定位射钉枪。这使得使用尽可能少的钉子，同时仍然确保良好的固定，这可以减少并发症的发生并降低手术成本。因此，基于上述优点，这里描述的网片固定方法非常适合临床应用。

对研究中的患者进行“对位对齐”网片固定（实验组）或传统双环疝气甲固定术（对照组），每组42例。
在本研究中进行的疝气修复手术期间，在缝合疝环后放置抗粘连网。在实验组中，采用“对位对齐”方法放置网片，而对照组采用传统的双环固定法放置网片。
该协议的第 3 部分详细介绍了具体的网格放置方法（图 1、图 <strong cl...

Watch this Scientific Journal Video about Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair at JoVE.com

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

这里介绍的是一种改善腹腔镜切口疝修补术中补片放置的方法，该方法可以缩短补片固定所需的时间，减少术后慢性疼痛的发生。

新型网片固定方法在腹腔镜切口疝修补术中的应用

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing ...

该方案为有效解决腹腔镜切口疝修补术中的网片固定问题提供了一种新方法。这种方法的优点包括准确的网格定位、牢固的固定和易于学习，特别是对于初学者。掌握了这种方法后，可以显著减少操作过程中的网片固定时间。文字和图片演示无法有效展示这种网格固定方法的整个过程，因此，视觉演示可以理解该方法的所有细节。首先选择合适尺寸的防粘连网，用无菌尺和标记笔测量并标记腹壁表面上切口疝的大致范围。疝环缺损的大小也可以通过术前CT检查来测量。将尺子平行于疝气缺损的纵轴放置，并测量缺损的最大纵向长度。根据疝环缺损的大小选择适当尺寸的防粘连网。确保网格的覆盖范围超过缺陷边缘至少 5 厘米。在网格上标记缺陷的纵向长度，并在纵轴上以五厘米的间隔标记射钉枪固定点。然后将固定点沿标记线延伸五厘米以上，直到与对齐有关的网格边缘。沿着与对位有关的网状物边缘每隔两到三厘米均匀地标记射钉枪固定点。确保射钉枪的固定点在两侧距缺陷纵轴线两厘米处均匀标记，间隔为三厘米。滚动网，使防粘连表面面向腹壁，并通过12毫米穿刺孔将卷起的网孔放入腹腔中。然后在腹腔镜引导下展开网片。确保展开的网片的标记线与疝环缺损的纵轴重叠。使用射钉枪用不可吸收的钉子将网孔纵轴上的标记点固定在腹壁上。使用射钉枪用不可吸收的钉子沿着网状边缘上的标记点将网状物的边缘固定在腹壁上。使用射钉枪用可吸收的钉子将网格沿网格纵轴两侧的标记点固定在腹壁上。实验组和对照组分别进行对位网片固定或传统双环疝气钉固定，每组42例。实验组的平均网格放置时间约为32.5分钟，明显低于对照组，网格放置时间约为44.7分钟。实验组只有2例慢性疼痛，明显低于对照组观察到的8例。两组在血清肿形成、网片感染、切口疝复发、术后住院时间、住院费用等方面差异无统计学意义。确保网片放置准确且覆盖率足够，并且使用了精确的固定方法。对位对位网片固定方法的应用不仅限于切口疝修补术，还可用于腹腔镜造口旁疝网修复和腹腔镜食管裂孔疝片修复。

Research

JoVE Journal

Medicine

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

快速点护理依诺肝素的抗凝血剂功效的测定全血中

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the ...

科研

医学

A Simple Method of Mouse Lung Intubation

一个简单的方法小鼠肺插管

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

A New Murine Model of Endovascular Aortic Aneurysm Repair

一种新的小鼠模型主动脉瘤腔内修复

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Studying Pancreatic Cancer Stem Cell Characteristics for Developing New Treatment Strategies

研究胰腺癌干细胞特性开发新的治疗策略

Pancreatic ductal adenocarcinoma (PDAC) contains a subset of exclusively tumorigenic cancer stem cells (CSCs) which have been shown to drive tumor ...

Tissue Characterization after a New Disaggregation Method for Skin Micro-Grafts Generation

后皮肤微移植生成一个新的方法解聚表征的组织

Several new methods have been developed in the field of biotechnology to obtain autologous cellular suspensions during surgery, in order to provide one ...

Open Tracheostomy Gastric Acid Aspiration Murine Model of Acute Lung Injury Results in Maximal Acute Nonlethal Lung Injury

急性肺损伤开放气管切开胃酸吸入小鼠模型结果在急性最大非致命性肺损伤

Acid pneumonitis is a major cause of sterile acute lung injury (ALI) in humans. Acid pneumonitis spans the clinical spectrum from asymptomatic to acute ...

Transvaginal Mesh Insertion in the Ovine Model

经阴道网格插入在牛模型中

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided ...

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh

使用可吸收的生物合成网格对副食管气喘进行拉帕罗镜修复

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been ...

A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the ...

Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings

Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings

桫椤幼虫在门诊压力伤口清创中的应用

Biological therapy using Lucilia sericata larvae has numerous advocates worldwide, yet it is still fairly unknown and not commonly applied in daily ...