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Application of a novel material in the inguinal region using a totally percutaneous approach in an animal model: a new potential technique?

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Abstract

Purpose

To evaluate the feasibility and safety of a new percutaneous image-guided surgery technique to simulate a hernia repair using hydrogel.

Materials and methods

A comparative prospective study was conducted in animals, with survival. Five pigs without any hernias were used. A hydrogel was injected at a site corresponding to the preperitoneal inguinal region. This procedure was performed bilaterally. An image-guided needle (ultrasound and computed tomography) was used, through which the material was injected. After survival, the local and systemic inflammatory reaction generated by the new material, was studied.

Results

All animals survived the procedure. No hemorrhagic or infectious complications were reported. The solidification of the material occurred as expected. In eight out of ten cases, the material was found in the planned site. No systemic inflammatory reaction secondary to the administration of hydrogel was reported. The adhesion of the material to surrounding tissues was satisfactory.

Conclusion

The introduction of a liquid material which solidifies after injection in a short time (hydrogel) using a needle is feasible. The combined CT-scan and US image guidance allows for the percutaneous placement of the needle in the required location. The introduced hydrogel remains in this space, corresponding to the inguinal region, without moving. The placed hydrogel compresses the posterior wall composed of the transversalis fascia, supporting the potential use of hydrogel for hernia defects.

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References

  1. Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin N Am 73(3):413–426

    Article  CAS  Google Scholar 

  2. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571. https://doi.org/10.1016/S0140-6736(03)14746-0

    Article  PubMed  Google Scholar 

  3. Miyaki A, Yamaguchi K, Kishibe S, Ida A, Miyauchi T, Naritaka Y (2017) Diagnosis of inguinal hernia by prone- vs. supine-position computed tomography. Hernia 21(5):705–771. https://doi.org/10.1007/s10029-017-1640-9

    Article  CAS  PubMed  Google Scholar 

  4. Pirolla EH, Patriota GP, Pirolla FJC, Ribeiro FPG, Rodrigues MG, Ismail LR, Ruano RM (2018) Inguinal repair via robotic assisted technique: literature review. Arq Bras Cir Dig 31(4):e1408. https://doi.org/10.1590/0102-672020180001e1408

    Article  PubMed  PubMed Central  Google Scholar 

  5. Davrieux CF, Gimenez ME, Gonzalez CA, Ancel A, Guinin M, Fahrer B, Serra E, et al. (2019) Mixed reality navigation system for ultrasound-guided percutaneous punctures: a pre-clinical evaluation. Surg Endosc. https://doi.org/10.1007/s00464-019-06755-5

  6. Gomez-Gil V, Rodriguez M, Garcia-Moreno Nisa F, Perez-Kohler B, Pascual G (2019) Evaluation of synthetic reticular hybrid meshes designed for intraperitoneal abdominal wall repair: preclinical and in vitro behavior. PLoS ONE 14(2):e0213005. https://doi.org/10.1371/journal.pone.0213005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ferruti P (2013) Poly(amidoamine)s: past, present, and perspectives. J Polym Sci Part A Polym Chem 51(11):2319–2353. https://doi.org/10.1002/pola.26632

    Article  CAS  Google Scholar 

  8. Ahmed EM (2015) Hydrogel: Preparation, characterization, and applications: a review. J Adv Res 6(2):105–121. https://doi.org/10.1016/j.jare.2013.07.006

    Article  CAS  PubMed  Google Scholar 

  9. Fiorini F, Prasetyanto EA, Taraballi F, Pandolfi L, Monroy F, Lopez-Montero I, Tasciotti E et al (2016) Nanocomposite hydrogels as platform for cells growth, proliferation, and chemotaxis. Small 12(35):4881–4893. https://doi.org/10.1002/smll.201601017

    Article  CAS  PubMed  Google Scholar 

  10. Alonci G, Fiorini F, Riva P, Monroy F, López-Montero I, Perretta S, De Cola L (2018) Injectable hybrid hydrogels, with cell-responsive degradation, for tumor resection. ACS Appl Bio Mater 1(5):1301–1310. https://doi.org/10.1021/acsabm.8b00189

    Article  CAS  Google Scholar 

  11. Kot BC, Zhang ZJ, Lee AW, Leung VY, Fu SN (2012) Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings. PLoS ONE 7(8):e44348. https://doi.org/10.1371/journal.pone.0044348

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD004703. https://doi.org/10.1002/14651858.CD004703.pub2

  13. Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26(12):3355–3366. https://doi.org/10.1007/s00464-012-2382-5

    Article  PubMed  Google Scholar 

  14. McCormack K, Scott NW, Go PM, Ross S, Grant AM, Collaboration EUHT (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785. https://doi.org/10.1002/14651858.CD001785

  15. Dhumane P, Donatelli G, Chung H, Dallemagne B, Marescaux J (2013) Feasibility of transumbilical flexible endoscopic preperitoneoscopy (FLEPP) and its utility for inguinal hernia repair: experimental animal study. Surg Innov 20(1):5–12. https://doi.org/10.1177/1553350612458727

    Article  PubMed  Google Scholar 

  16. Sherwinter DA, Gupta A, Eckstein JG (2011) Natural orifice translumenal endoscopic surgery inguinal hernia repair: a survival canine model. J Laparoendosc Adv Surg Tech A 21(3):209–213. https://doi.org/10.1089/lap.2010.0549

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hagopian EJ, Steichen FM, Lee KF, Earle DB (2001) Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair. Surg Endosc 15(3):324. https://doi.org/10.1007/s004640040039

    Article  CAS  PubMed  Google Scholar 

  18. Edelman DS (2017) Robotic inguinal hernia repair. Am Surg 83(12):1418–1421

    PubMed  Google Scholar 

  19. Charles EJ, Mehaffey JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z (2018) Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc 32(4):2131–2136. https://doi.org/10.1007/s00464-017-5911-4

    Article  PubMed  Google Scholar 

  20. Korkmaz M, Guvenc BH (2018) Comparison of single-port percutaneous extraperitoneal repair and three-port mini-laparoscopic repair for pediatric inguinal hernia. J Laparoendosc Adv Surg Tech A 28(3):337–342. https://doi.org/10.1089/lap.2016.0223

    Article  PubMed  Google Scholar 

  21. Shibuya S, Fujiwara N, Ochi T, Wada M, Takahashi T, Lee KD, Miyazaki E (2019) The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees. BMC Surg 19(1):6. https://doi.org/10.1186/s12893-019-0470-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shibuya S, Miyazaki E, Miyano G, Imaizumi T, Mikami T, Ochi T, Koga H et al (2019) Comparison of laparoscopic percutaneous extraperitoneal closure versus conventional herniotomy in extremely low birth weight infants. Pediatr Surg Int 35(1):145–150. https://doi.org/10.1007/s00383-018-4386-2

    Article  PubMed  Google Scholar 

  23. Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S (2014) Role of imaging in the diagnosis of occult hernias. JAMA Surg 149(10):1077–1080. https://doi.org/10.1001/jamasurg.2014.484

    Article  PubMed  Google Scholar 

  24. Gimenez ME (2019) Percutaneous image-guided surgery. Int J Gastrointest Interv 8(1):2–5

    Article  Google Scholar 

  25. Junge K, Binnebösel M, Rosch R, Jansen M, Kämmer D, Otto J, Schumpelick V et al (2009) Adhesion formation of a polyvinylidenfluoride/polypropylene mesh for intra-abdominal placement in a rodent animal model. Surg Endosc 23(2):327–333. https://doi.org/10.1007/s00464-008-9923-y

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to Dr. Veronique Lindner, from the pathology dept. of the Nouvel Hôpital civil of Strasbourg, for their valuable contribution.

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Authors and Affiliations

  1. Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire-Strasbourg, Strasbourg, France

    M. E. Giménez, C. F. Davrieux, A. Garcia Vazquez, B. Dallemagne, M. Diana & J. Marescaux

  2. IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France

    M. E. Giménez, C. F. Davrieux, B. Dallemagne, M. Diana & J. Marescaux

  3. DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina

    M. E. Giménez, C. F. Davrieux, M. Palermo, E. J. Houghton & A. Garcia Vazquez

  4. University of Buenos Aires, Buenos Aires, Argentina

    M. E. Giménez, E. Serra & E. J. Houghton

  5. University of Strasbourg, Strasbourg, France

    M. E. Giménez, G. Alonci, E. Piantanida, J. Marescaux & L. De Cola

  6. Pathology Department, Nouvel Hôpital Civil of Strasbourg, Strasbourg, France

    V. Lindner

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  1. M. E. Giménez
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  2. C. F. Davrieux
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  3. E. Serra
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  4. M. Palermo
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  6. G. Alonci
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  7. E. Piantanida
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  8. A. Garcia Vazquez
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  9. V. Lindner
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  10. B. Dallemagne
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  11. M. Diana
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  12. J. Marescaux
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  13. L. De Cola
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Corresponding author

Correspondence to M. E. Giménez.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The present study was a prospective and experimental study in animals, which obtained full approval of the Institutional and National Ethics Committee (Number ID: APAFIS#10613-2017071315487959 v1) and with due deference to French laws for animal use and care and to the European Community Council Directive (2010/63/EU). It was held at Strasbourg’s Institute of Image-guided Surgery (IHU), France.

Human and animal rights

This article does not contain any human participants. Ethical principles (refinement, replacement, and reduction) were strictly respected for animal experimentation.

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Giménez, M.E., Davrieux, C.F., Serra, E. et al. Application of a novel material in the inguinal region using a totally percutaneous approach in an animal model: a new potential technique?. Hernia 23, 1175–1185 (2019). https://doi.org/10.1007/s10029-019-01999-5

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  • DOI: https://doi.org/10.1007/s10029-019-01999-5

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