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Stangel-Wójcikiewicz K, Murawski M, Schwarz T, Skotniczny K, Fuchs A, Wolski J, Radwan-Pragłowska J, Janus Ł, Piątkowski M, Kot M, Wróbel A, Wojtysiak D, Urbaniec P. Pelvic Organ Prolapse Reconstruction with the Chitosan-Based Novel Haemostatic Agent in Ovine Model-Preliminary Report. Int J Mol Sci 2024; 25:3801. [PMID: 38612610 PMCID: PMC11011902 DOI: 10.3390/ijms25073801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
This prospective study aimed to assess the feasibility of chitosan biomaterial and subcutaneous gel implantation in an ovine model, with implications for women with genital prolapse. Twenty-four ewes were divided into four groups (n = 6 per group): chitosan type B, chitosan type C, chitosan unmodified injections, and polypropylene mesh. Ovine models were chosen due to their morphological resemblance to human reproductive organs. Animals were sacrificed after 90 days for macroscopic, pathomorphological, and immunohistochemical analysis. In the chitosan type B group, IL-6 and IL-10 levels decreased after 28 days, while chitosan type C and injection groups exhibited higher IL-6 than IL-10 levels. The polypropylene group displayed the highest IL-6 and lowest IL-10 levels. Histological examination of the polypropylene group revealed no degenerative changes or inflammation, whereas chitosan injection induced local inflammation. Other groups exhibited no degenerative changes. Ewes implanted with chitosan displayed reduced inflammation compared to polypropylene-implanted ewes. Chitosan implantation facilitated vaginal tissue healing, in contrast to polypropylene mesh, which led to extrusion. While chitosan holds promise as an alternative to polypropylene mesh, further research is imperative for comprehensive evaluation. This study suggests the potential of a chitosan biomaterial in pelvic organ prolapse treatment, warranting additional investigation.
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Affiliation(s)
- Klaudia Stangel-Wójcikiewicz
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Maciej Murawski
- Department of Animal Nutrition, Biotechnology and Fisheries, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland;
| | - Tomasz Schwarz
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
| | - Krzysztof Skotniczny
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Agnieszka Fuchs
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Jan Wolski
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Julia Radwan-Pragłowska
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Łukasz Janus
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marek Piątkowski
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marta Kot
- Department of Transplantation, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, ul. Wielicka 265, 30-663 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Dorota Wojtysiak
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
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Dillon S. Simulation in Obstetrics and Gynecology: A Review of the Past, Present, and Future. Obstet Gynecol Clin North Am 2021; 48:689-703. [PMID: 34756290 DOI: 10.1016/j.ogc.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation in obstetrics and gynecology has advanced significantly since its beginnings in the seventeenth century with wooden birthing and pelvic models. In recent years, more and more evidence has emerged showing improvements in participant confidence, skills, behaviors, and, finally, patient outcomes following simulation program implementation. Several regulatory bodies and national organizations have begun to require simulation of obstetrician-gynecologists, and the newer generation of physicians has experienced simulation throughout their training. Simulation is embedded in the medical culture and hopefully is making obstetrician-gynecologists better for it.
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Affiliation(s)
- Shena Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
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Chan KL, Yeung CK, Lam KW, Cheung JLK, Sreedhar B, Ngan HY. Robotic Natural Orifice Transluminal Endoscopic Surgery Hysterectomy and Salpingo-Oophorectomy in a Porcine Model. Surg Innov 2021; 29:215-224. [PMID: 33980081 DOI: 10.1177/15533506211018433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. The emergence of robotic-assisted surgical techniques has gained significant indications in terms of reduced trauma, shortened recovery, and higher patients' satisfaction. However, limitations by present surgical robotic systems used in natural orifice transluminal endoscopic surgery (NOTES) gynecology still exists, such as arm collisions, countertraction, instrument dexterity, and, in particular, space confinement due to the narrow pelvic anatomy. The current study evaluated the use of a miniaturized single-site surgical robotic system and its feasibility in performing robotic NOTES gynecological procedures using a live porcine animal model. Methods. Using a transrectal approach, the fully internalized robotic arms were deployed in a reverse configuration to access the lower pelvic cavity of the animals to perform NOTES gynecological procedures. Results. Robotic-assisted transrectal gynecological procedures were successfully performed using the new robotic system. A hemi-hysterectomy with unilateral salpingo-oophorectomy was completed in the first animal and a total hysterectomy with bilateral salpingo-oophorectomy in the second animal with an average docking time of 22.5 minutes and console time of 63 minutes and 58 minutes, respectively. The overall blood loss for each procedure was estimated to be <20 mL per animal with no intraoperative complications. Conclusions. The reverse configuration of the miniaturized surgical robotic system has demonstrated its capability to provide a potential solution to maintain clear visualization of the surgical field, optimal triangulation, and dexterity robotic NOTES gynecological procedures within the deep confined space of the pelvic cavity.
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Affiliation(s)
- KarenKar-Loen Chan
- Li Ka Shing Faculty of Medicine, Department of Obstetrics & Gynaecology, 25809The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung-Kwong Yeung
- Department of Surgery, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong, Hong Kong.,Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong
| | - Kwok-Wai Lam
- Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong.,Li Ka Shing Faculty of Medicine, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Biji Sreedhar
- Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong
| | - Hextan Ys Ngan
- Li Ka Shing Faculty of Medicine, Department of Obstetrics & Gynaecology, 25809The University of Hong Kong, Hong Kong, Hong Kong
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Alshiek J, Marroquin J, Shobeiri SA. Vaginal ultrasound-guided Pouch of Douglas robotic entry in a live ovine model and human female cadaveric specimens. J Robot Surg 2021; 16:73-79. [PMID: 33576913 DOI: 10.1007/s11701-021-01203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We aimed to determine whether intraoperative ultrasound is a feasible tool for visualization of the pouch of Douglas (POD) to facilitate a safe vaginal entry for direct robotic vaginal trocar insertion for pelvic floor surgery. Endovaginal ultrasound-guided needle insertion of a trocar into the POD was performed in six fresh frozen female cadavers and a live sheep animal model. Using an endovaginal probe the POD was identified as a fluid-filled space clear of bowel or adhesions, then a Veress needle was also used to confirm POD localization. Access to the POD was achieved using a robotic trocar designed for this purpose. The animal study was approved by the Ethics Committee of Asaf-Harofe hospital. Direct visualization during laparoscopy in cadavers and open cadaveric dissections confirmed safe POD entry and accurate trocar placement. This method was found feasible in the development of a safe vaginal entry in both the animal and cadaveric model, possibly negating the need for laparoscopic umbilical observation.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Hillel Yafe Hospital, Hadera, Israel.,Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA.,Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA. .,Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Alshiek J, Marroquin J, Shobeiri SA. The Fresh Frozen Cadaveric Study of Direct Pouch of Douglas Laparoscopic and Robotic Trocar Insertion for Vaginal Natural Orifice Transluminal Endoscopic Surgery. J Minim Invasive Gynecol 2020; 28:320-324. [PMID: 32540501 DOI: 10.1016/j.jmig.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. DESIGN Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. SETTING Inova Advanced Simulation and Technology Evaluation Center. PATIENTS Fresh frozen cadavers with intact reproductive organs. INTERVENTIONS Vaginal POD trocar insertion. MEASUREMENTS AND MAIN RESULTS Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. CONCLUSION A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia; Department of Obstetrics & Gynecology, Hillel Yafe Hospital, Technion Medical School, Hadera, Israel (Dr. Alshiek)
| | - Joanna Marroquin
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors)
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia.
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