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. 2017 Oct;21(5):783-791.
doi: 10.1007/s10029-017-1615-x. Epub 2017 Apr 20.

The 'AbdoMAN': an artificial abdominal wall simulator for biomechanical studies on laparotomy closure techniques

L F Kroese  1 , J J Harlaar  2 , C Ordrenneau  3 , J Verhelst  4 , G Guérin  3 , F Turquier  3 , R H M Goossens  5 , G-J Kleinrensink  6 , J Jeekel  6 , J F Lange  4
Affiliations

The 'AbdoMAN': an artificial abdominal wall simulator for biomechanical studies on laparotomy closure techniques

L F Kroese et al. Hernia. 2017 Oct.

Abstract

Purpose: Incisional hernia remains a frequent complication after abdominal surgery associated with significant morbidity and high costs. Animal and clinical studies have exhibited some limitations. The purpose of this study was to develop an artificial human abdominal wall (AW) simulator in order to enable investigations on closure modalities. We hypothesized that a physical model of the human AW would give new insight into commonly used suture techniques representing a substantial complement or alternative to clinical and animal studies.

Methods: The 'AbdoMAN' was developed to simulate human AW biomechanics. The 'AbdoMAN' capacities include measurement and regulation of intra-abdominal pressure (IAP), generation of IAP peaks as a result of muscle contraction and measurements of AW strain patterns analyzed with 3D image stereo correlation software. Intact synthetic samples were used to test repeatability. A laparotomy closure was then performed on five samples to analyze strain patterns.

Results: The 'AbdoMAN' was capable of simulating physiological conditions. AbdoMAN lateral muscles contract at 660 N, leading the IAP to increase up to 74.9 mmHg (range 65.3-88.3). Two strain criteria were used to assess test repeatability. A test with laparotomy closure demonstrated closure testing repeatability.

Conclusions: The 'AbdoMAN' reveals as a promising enabling tool for investigating AW surgery-related biomechanics and could become an alternative to animal and clinical studies. 3D image correlation analysis should bring new insights on laparotomy closure research. The next step will consist in evaluating different closure modalities on synthetic, porcine and human AW.

Keywords: Abdominal wall; Biomechanics; Incisional hernia; Laparotomy closure.

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Conflict of interest statement

Conflict of interest

LK declares no conflict of interest directly related to the submitted work. JH declares no conflict of interest directly related to the submitted work. CO declares conflict of interest not directly related to the submitted work (Medtronic employment). JV declares no conflict of interest directly related to the submitted work. GG declares conflict of interest not directly related to the submitted work (Medtronic employment). FT declares conflict of interest not directly related to the submitted work (Medtronic employment). RG declares no conflict of interest directly related to the submitted work. JJ declares no conflict of interest directly related to the submitted work. GK declares no conflict of interest directly related to the submitted work. JL declares no conflict of interest directly related to the submitted work.

Ethical approval

This study did not need approval from the local ethical committee.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of article informed consent is not required.

Funding

Supported by Medtronic, Trévoux, France.

Figures

Fig. 1
Fig. 1
‘AbdoMAN’ device. a Schematic overview showing all different components. b Side view showing three lateral muscle actuators connected to the mounted sample and the cranial/caudal jaws used to mount the sample. c Top view showing an intact sample mounted on the ‘AbdoMAN’ using jaws on all four sides
Fig. 2
Fig. 2
Abdominal wall samples. a Shape of a sample prior to mounting. b A mounted sample on the ‘AbdoMAN’ device with fixation in four directions
Fig. 3
Fig. 3
Synthetic abdominal wall stiffness testing. Each sample was tested in two directions (D1 and D2)
Fig. 4
Fig. 4
‘AbdoMAN’ test setup repeatability results. a Synthetic abdominal wall stiffness determined by tensile machine testing of a small piece of each sample. b Peak intra-abdominal pressure during cough cycle of the samples mounted on the ‘AbdoMAN’. c Mean strain over surface area of the samples mounted on the ‘AbdoMAN’. d Mean strain over transversal line of the samples mounted on the ‘AbdoMAN’
Fig. 5
Fig. 5
3D stereo correlation criteria of intact samples. a Exemplary strain image of an intact synthetic abdominal wall sample at peak intra-abdominal pressure. b Schematic image of used strain analysis areas for 3D stereo correlation: linear strain in the muscle force direction and area strain of a larger surface area
Fig. 6
Fig. 6
3D stereo correlation criteria of 5 × 5 mm suture modality. a Mean maximum strain around suture points. The areas are indicated in the white circles. b Peak-to-peak normalized strain profile through the suture points. Maximum and minimum peaks are indicated and connected with the green lines. c Maximum opening length of the incision. This is indicated with the red line
Fig. 7
Fig. 7
Midline closure repeatability results. a Mean maximum strain around suture points as indicated in Fig. 6a. b Peak-to-peak normalized strain profile through the suture points as indicated in Fig. 6b. c Maximum opening length of the incision as indicated in Fig. 6c
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References

    1. Bevis PM, Windhaber RA, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC. Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg. 2010;97(10):1497–1502. doi: 10.1002/bjs.7137. - DOI - PubMed
    1. van’t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350–1356. doi: 10.1046/j.1365-2168.2002.02258.x. - DOI - PubMed
    1. Webster C, Neumayer L, Smout R, Horn S, Daley J, Henderson W, Khuri S, National Veterans Affairs Surgical Quality Improvement P Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res. 2003;109(2):130–137. doi: 10.1016/S0022-4804(02)00097-5. - DOI - PubMed
    1. van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg. 2012;204(2):144–150. doi: 10.1016/j.amjsurg.2012.01.012. - DOI - PubMed
    1. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16(2):179–183. doi: 10.1007/s10029-011-0879-9. - DOI - PubMed