A biomechanical analysis of cervical fixation methods (tacks vs. sutures) for laparoscopic apical fixation in a porcine model

Introduction The incidence of apical uterine prolapse increases with age and often requires surgical correction with the use of alloplastic material. Laparoscopic cervicosacropexy is frequently performed, different materials (tacks vs. sutures) can be used to fix the mesh material to the cervix for apical fixation. The aim of this in-vitro study was to compare the biomechanical properties for fixation of PVDF-mesh to porcine cervix with single-button sutures and two types of tacks.

Materials Biomechanical ex-vivo testing was performed on porcine fresh cadaver uteri. In a two-column-material-testing machine (Instron 5565) a total of 28 trials were conducted in 3 groups on fresh porcine uteri. Each group evaluated the cervical mesh (polyvinylidene-fluoride (PVDF) fixation with a different fixation device: Group 1 (n=10) evaluated three interrupted sutures, group 2 (n=10) three titanium tacks (ProTack), and group 3 (n=8) three absorbable tacks (AbsorbaTack).

Results Significant differences were found between all three groups in terms of maximum load: Group 1 showed a maximum load of 64 ± 15N, Group 2 41 ± 10N and Group 3 reached a maximum load of 15 ± 8N. The most common mode of failure for group 1 and 2 was a mesh tear or rip under 80-times of maximum load. In group 3, the limiting factor was a pull-out of the absorbable tacks.

Conclusions Single-button sutures are the significantly stronger and less expensive but could increase operating time (when fixating the mesh) by factor 9 compared to tacks. Possible risks of the tacks are not considered in this in vitro analysis.

Publication History

Article published online:
11 October 2022