New method helps to reliably distinguish surgical meshes from normal bodily tissue

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Prototypes of surgical meshes that can be seen clearly on CT scans have been developed by researchers at UCL for the first time, promising to increase the speed at which problems can be diagnosed and resolved.

The study, published in Advanced Science, presents the first method of reliably distinguishing surgical meshes used in abdominal hernia surgery from normal bodily tissue.

Hernia happens when an internal part of the body pushes through the surrounding muscle and tissue, creating a bulge. Around a quarter of men will experience a hernia in their lifetime, making hernia surgery the most commonly performed operation in the world.

As these surgical meshes are commonly made from biological material, they bind with the surrounding tissue to reinforce the area - but this also means the mesh becomes difficult to distinguish from normal tissue, something that creates real problems when these patients need re-operation because surgeons cannot determine what has been done before.

In this study, researchers from UCL were challenged by surgeons at UCLH to come up with a solution to identify implanted surgical meshes.

They repurposed an old type of chemistry, normally used to bind radioactive iodine isotopes to proteins such as antibodies for the purposes of detecting diseases. By swapping the radioactive iodine for a stable, non-radioactive isotope, they were able to engineer them into protein-based surgical meshes so that they would show up more clearly on CT scans, which are used commonly for planning surgery.

Materials scientists tested these visible meshes to ensure they had the same properties as the original material, before implanting them in mice and tracking their position over time using CT scanning. The results confirmed that the meshes were visible and could be reliably distinguished from normal tissue.

When colleagues at UCLH first posed the problem of surgical meshes being difficult to distinguish from normal tissue, our thoughts quickly turned to how we could label the material to make it visible to CT. In the end, we repurposed an old type of chemistry to do something new and to enhance X-ray absorption. The beauty of the approach is that it is also easy and cheap, so I'm confident that it could make a difference to patients in the near future."

Dr Stephen Patrick, senior author of the study from UCL Division of Medicine

The utility of the visible meshes to speed up diagnosis and treatment could mean significant time and cost savings for health services, as well as the patient welfare benefits resulting from fewer or shorter surgeries.

Lady Barrios-Silva, an author of the study from the UCL Eastman Dental Institute, said: "Our method of creating visible surgical meshes was also tested in surgical silk, opening up other possibilities for disease management. For example, it may be possible to use these visible sutures to label tumours, making it possible to orient surgical or beam therapy procedures, as well as detect any remaining cancer tissue after surgery. This new technology would be a more flexible option for the patient than using metal markers, as is currently the case."

The authors are exploring how to incorporate the technique into commercial meshes with producers in order to get them into the clinic where they will be able to address issues of visibility.

Professor Steve Halligan, an author of the study and a radiologist from UCL Division of Medicine, said: "The results of our study are very exciting. Ventral hernias are increasingly common and while most patients won't experience any issues after repair, when problems do occur they can be very tricky to resolve. We're already talking to manufacturers with a view to getting the technology into the clinic and start making a difference for patients as soon as possible."

Source:
Journal reference:

Becerra, C. F., et al. (2023). X‐Ray Visible Protein Scaffolds by Bulk Iodination. Advanced Science. doi.org/10.1002/advs.202306246.

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