INTERNAL AFFAIRS Many choices are available to assist surgeons in placing and securing surgical mesh.

Among general surgeons, there is a general consensus that the laparoscopic approach to hernia repair has greatly improved patient outcomes, providing less post-operative pain, accelerated recoveries and more durable repairs. Mesh is the preferred solution for these minimally invasive procedures, and a crop of devices has emerged to assist laparoscopic surgeons in inserting, positioning and placing the material faster, more accurately and more efficiently.

If you and your surgeons are looking to improve on their hernia repair techniques and processes, however, be sure to trial options with a cost-benefit critical eye, says one industry observer. "Is their price-point realistic?" he asks. "There are mesh products on the market that don't require special positioners to net excellent results." Buying single-use instruments to put the mesh in place is "doubling the cost of the implant," he adds. "As with any purchase, be sure to question the cost-benefit value."

Here's a roundup of some of the latest mesh products, positioning tools and fixation options.

Atrium Medical
C-QUR CentriFX Mesh
www.atriummed.com/centrifx
(800) 528-7486
List price: not disclosed
FYI: Atrium Medical's CentriFX mesh is made from the absorbable, same omega-3-fatty-acid-coated filament polypropylene as the company's C-QUR line of meshes. It improves on it by incorporating a pre-shaped, multi-dimensional, anatomically correct design that aligns with vessels and cord structures in the inguinal space. Combined, these 2 features provide biocompatibility and conforming coverage for laparoscopic hernia repairs. The mesh's translucence enables accurate implantation, positioning and fixation, while its invertible design allows its use in both right- and left-sided hernias. It's available in 3 sizes and modifiable for specific situations, says the company, now a member of the Maquet Getinge group.

Bard Davol
Echo PS Positioning System
www.davol.com
(800) 556-6275
List price: not disclosed
FYI: The Echo PS Positioning System from Bard Davol offers easier, more efficient mesh deployment, placement and positioning for laparoscopic ventral hernia repair. The system employs a low-profile, inflatable positioner pre-attached to a piece of Ventralight ST or Composix L/P mesh. The mesh is rolled and inserted through a trocar at the surgical site. Inflating the positioner unrolls the mesh, keeping it open and holding it against the abdominal wall without the need for additional trocar sites, graspers, spreading devices or orientation sutures. Once the mesh is initially fixated, the positioner is deflated and removed.

Covidien
AccuMesh Positioning System
www.covidien.com/hernia
(800) 722-8772
List price: not disclosed
FYI: Successful laparoscopic ventral hernia repair depends on ensuring a consistent 3cm to 5cm overlap of mesh at the edges of the defect, says Covidien, whose first entry into the mesh positioning field assists in delivering accuracy and speed to insertion, deployment and placement. The easy-to-assemble AccuMesh Positioning System features an expanding frame and 100 degrees of articulation at the distal end to introduce and center Parietex Optimized Composite (PCOx) mesh. Those actions, along with a deployment slider and mesh release lever, are controlled from the ergonomically designed handpiece.

Nashville Surgical Instruments
Kumar T- Anchors Hernia Set
www.nashvillesurg.com
(615) 382-4996
List price: $570 for 10 sets (each including introducer tools and 8 anchors) FYI: This laparoscopic fixation system enables trans-fascial suturing of mesh to the abdominal wall, as a supplement to staples or tacks, without having to grasp and feed suture into a passer. Kumar T-Anchors are made from 20-gauge tubing (on the horizontal axis of the T) and 22cm-long 0 polyamide suture (on the vertical). After mesh has been placed, it is secured at the corners or edges by pairs of the anchor sutures, which are percutaneously installed by way of an introducer needle and pusher stylet. Pulling on the anchor sutures pulls the mesh to the abdominal wall for centering, and knotting them secures it for stapling or tacking.

SafeStitch Medical
AMID Hernia Fixation Device
www.safestitch.com
(877) 723-3271
List price: $495, variable depending on volume purchased FYI: In a single tool, the AMID Hernia Fixation Device from SafeStitch Medical pulls triple duty for inguinal and ventral hernia repairs. It engages the mesh to manipulate it to its optimal position, affixes it with less retraction force than manual suturing requires (for less post-op pain), and can even be used for skin closure. The ergonomic handle provides users with comfort and control, and the angled design makes access through incisions easier. The AMID device is loaded with 17 titanium staples, which it delivers in a parallel plane to the femoral vessels, in order to avoid penetrating delicate vessels and nerves.