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Abstract
Purpose
Most recently developed anti-adhesive membranes are not suitable for laparoscopic surgery due to weak mechanical properties or adhesive characteristics. To overcome these problems, we prepared electrospun bioabsorbable nanofibrous poly (lactic-co-glycolic acid)-based membranes as an adhesion barrier. We evaluated the efficacy and safety of this material for laparoscopic surgery in a rabbit model.
Methods
A standardized laparoscopic surgical trauma was made on the rabbit's uterine horn and adjacent abdominal wall to induce adhesion formation. The injured uterus was covered by a nanofibrous barrier or it was left untreated (the negative control group) (each group: n=14). To evaluate acute toxicity of this material, blood sampling was made 3 and 7 days after laparoscopic surgery to check liver and renal function. Three weeks after laparoscopy, a second look laparoscopy was performed and the adhesions were scored according to Blauer's scoring system. Tissue between abdominal wall and uterus was obtained to examine microscopically. Liver, kidney and uterus were harvested to examine chronic toxicity.
Results
36.4% of the nanofiber treatment group and 70% of the untreated control group showed severe adhesions (grade>3) after laparoscopic surgery but failed to get a statistical significance (P=0.198). Acute and chronic toxicity induced by this material were not noted in the blood and tissue exam.
Conclusion
This study showed that nanofiber barrier seems to be a novel resorbable biomaterial for the reduction of postoperative adhesions. Easy placement and handling of this material make these membranes potentially successful candidates for laparoscopic surgery. But further study is needed to get a statistical significance.
Figures and Tables
Fig. 1
(A) Electrospun PLGA nanofibrous adhesion barrier and (B) its scanning electron microscopy (×1,500).
Fig. 2
Evaluation of acute toxicity at 3 days and 7 days postsurgery. (A) GOT, (B) GPT, (C) BUN, (D) CRE (*P>0.05).
Fig. 3
Classification of adhesion severity during laparoscopy at 3 weeks postsurgery. (A) Grade 0 = no adhesion, (B) Grade 1 = thin or narrow adhesion, (C) Grade 2 = thick adhesion, limited to one area, (D) Grade 3 = thick and widespread adhesion, (E) thick and widespread adhesion, plus adhesions of adjacent viscera.
Fig. 5
Histological findings at 3 weeks postsurgery. (A) Uterus of control group, (B) Abdominal wall of control group, (C) Uterus of nanofiber group, (D) Abdominal wall of nanofiber group. Any significant difference of extent or depth of inflammatory reaction between the two groups in the uterine serosa (A and C) or abdominal wall (B and D) is not identified (H&E stain, ×40).
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