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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_874_Библиотеки_им_академика_М_И_Перельмана.pdf
76
K. A. LeBlanc
Repol Angimesh 0 (lightest), 1, 8, 9 (heaviest) are all similar and differentiated in
the weights and weaves from each other. SurgiMesh WN is a non-woven microber
PP product that is extremely lightweight and has a differing microstructure than the
other materials listed in this section (Fig.4.32). It is available in several congurations but cannot be placed against the viscera. Surgipro was originally introduced as
a multilament mesh. This product is softer than the monolament version
(Fig. 4.33). The open weave product is called Surgipro Open Weave (Fig. 4.34).
SMX is a heavy product (Fig.4.35). It is available in a lightweight and ultra light
material as SMH2 and SMH respectively (Fig.4.36). They are part of the “Swingmesh” product line.
TiMESH is a lightweight material that has titanium bonded onto the bers of the
PP using nanotechnology (Figs.4.37 and 4.38). This coating on the bers is said to
allow ingrowth of collagen in a exible manner due to the inhibition of the development of a thick scar plate. It is one of the few products in this section that can be
used in either the intraperitoneal or extraperitoneal positions. TiLENE Blue has blue
lines incorporated into the material to aid in positioning and can also be used in the
intra- or extra-peritoneal planes (Fig.4.39). It is also available without the blue lines
as TiLENE. TiO
Mesh is also a titanized PP that is lightweight (47g/m2), large pore
2
(2.8mm) and has blue orientation strips (Fig.4.40a). It is stated to be hydrophilic
so that there is an apparent “stickiness” to the product, which eases intraoperative
Fig. 4.32 SurgiMesh WN
4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.33 SurgiPro
monolament (All rights
reserved; used with
permission of Medtronic)
77
78
Fig. 4.34 Surgipro open
weave (All rights reserved;
used with permission of
Medtronic)
K. A. LeBlanc
4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.35 SMX
Fig. 4.36 SMH2
79
Fig. 4.37 TiMESH
80
Fig. 4.38 TiMESH SEM
Fig. 4.39 TiLENE blue
K. A. LeBlanc
ab
Fig. 4.40 (a) TiO2 mesh. (b) TiO2—GS
4 Prosthetic Materials forRobot-Assisted Hernia Repair
81
handling. It can be used in either open or laparoscopic inguinal and incisional hernia
repairs. It has been congured into the GS-Mesh implant that is 11×30cm and
indicated for bilateral inguinal hernia repair (Fig.4.40b).
VitaMesh is made of condensed PP rather than the traditional PP (Fig. 4.41).
These products are singular in that they are made of Regular PP mesh becomes
condensed PP mesh through compression during a post-knit heat treatment. This
condensing process serves to reduce mesh thickness approximately 70%. This is
said to improve deliverability through increased smoothness because ber crossover
points are attened. Improved recovery of the shape of the mesh is asserted because
the knots in the mesh are attened. This provides greater shape memory than their
2
non-attened PP. VitaMesh is the heavier weight version (50g/m
). There is also
available as a lighter weight version (28g/m2) as VitaMesh Blue and is easily dif-
ferentiated by its blue color (Fig.4.42).
The differences in the appearance of the prosthetics are easily seen in these photos. The size of the pores of these materials as well as the thickness of the product
will have a signicant impact on the stiffness. These factors affect the degree of
scarring within the tissues. Additionally, the pore sizes vary greatly from each of
these products. The lighter weight products have signicantly impacted the prosthetic repair of hernias. The current thought is that, for the most part, there is less
pain and scar plate with these lightweight, larger pore meshes. They also appear to
be easier to treat if they become infected than the heavier weight materials.
Like the polypropylene materials, the polyester at sheets can be used in inguinal
and ventral hernia repair (Table4.12). The preponderance of the polyester products
that are currently available is produced in various congurations and most have
some type of coating. These “tissue separating” products are listed later in this
Fig. 4.41 Vitamesh
82
Fig. 4.42 Vitamesh blue
K. A. LeBlanc
Table 4.12 Flat polyester
products
2D PET, Microval, Saint-Just-Malmont, France
Angimesh R2, Angiologica, S.Martino Sicc., Italy
Angimesh R2-1, Angiologica, S.Martino Sicc., Italy
Angimesh R2-9, Angiologica, S.Martino Sicc., Italy
Biomesh A2, Cousin Biotech, Wervicq-Sud, France
Parietex Flat Sheet Mesh, Medtronic, Minneapolis, MN, USA
Parietex Lightweight Mesh, Medtronic, Minneapolis, MN, USA
Parietex Monolament Macroporous Mesh, Medtronic,
Minneapolis, MN, USA
SM2, THT Bio- Science, Montpelier, France
SM3, THT Bio- Science, Montpelier, France
Versatex, Medtronic, Minneapolis, MN, USA
chapter. The ones discussed here are not coated and should not be used in the intraperitoneal space.
The 2D PET, Angimesh R2, R2-1, R2-9 and Biomesh A2 materials are all fairly simi-
lar in appearance. The 2D PET and Biomesh A2, however, has been congured into
various shapes and sized to allow use in open or laparoscopic inguinal and open ventral
hernia repair (Figs.4.43 and 4.44). Angimesh R2 is multilament polyester (Fig.4.45).
Angimesh R2-1 and R2-9 are monolament materials very similar in appearance and
differ only in thicknesses, R2-1 being thinner than R2-9 (Figs.4.46 and 4.47).
The Parietex Flat Sheet Mesh is available in two or three-dimensional weaves
(Fig.4.48). The 2D material is more rigid and is touted for robotic repairs due to this
4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.43 2D PET
Fig. 4.44 Biomesh A2
83
fact. The 3D product is more supple and soft. Parietex Lightweight product is a
monolament product (Fig.4.49). Parietex Monolament Macroporous is available
in a at sheet and is a two dimensional construct (Fig.4.50). SM2 is a heavyweight
bi-dimensional weave material that is indicated for all hernia repairs (Fig.4.51).
SM3 is a three-dimensional weave of pure polyester that is available in a variety
of shapes and sizes and can be used in open or robotic applications (Fig. 4.52).
Versatex has a 3D construct and is macroporous (Fig.4.53). It is a medium weight
(64 g/m2) monolament product and has a central teardrop to be used for
positioning.
Expanded polytetrauoroethylene (ePTFE) prostheses have also been available
in a at sheet conguration for many years (Table4.13). In fact, the earliest products
used in the intraperitoneal space for incisional hernia repair were of ePTFE [4].
Because of their structure, they are solid and white unless an antimicrobial agent has
been added.
The current DualMesh products are very similar in construction and are one of
the oldest “tissue-separating” products (Fig.4.54). These all have two distinctly different surfaces. One side (visceral surface) is very smooth and has interstices of
84
Fig. 4.45 Angimesh R2
K. A. LeBlanc
Fig. 4.46 Angimesh R2-1
three microns while the other (parietal surface) has the appearance of corduroy with
an approximate “ridge to ridge” distance of 1500 microns. This prosthesis is
designed for use in the intraperitoneal space. DualMesh is one millimeter in thickness and is available with the impregnation of silver and chlorhexidine as DualMesh
4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.47 Angimesh R2-9
Fig. 4.48 Parietex at
sheet (All rights reserved;
used with permission of
Medtronic, Inc.)
85
Fig. 4.49 Parietex
lightweight mesh (All
rights reserved; used with
permission of Medtronic,
Inc.)