title: Evaluation of surgical instrument handling on polypropylene mesh using scanning electron microscopy.
abstract: OBJECTIVE
  To evaluate the effect of surgical instruments handling on polypropylene mesh using scanning electron microscopy (SEM).
  
  
  METHODS
  We applied different surgical instruments, including a few robotic ones, to pieces of polypropylene mesh. SEM was used to evaluate the morphological changes with this intervention.
  
  
  RESULTS
  Straight hemostat, laparoscopic atraumatic grasper, laparoscopic needle driver, and robotic instruments (Bipolar forceps, Cadiere forceps, PK dissecting forceps and SutureCut) were applied to the mesh. SEM images of tool-affected mesh regions in specimens handled by different instruments along with the images of intact mesh were obtained. Average mesh fiber diameters, as well as the average parameters characterizing instrument-affected regions, were measured. There was substantial widening of the fibers in specimens handled by hemostat or a needle holder. An elliptical but much longer and narrower tool marking with more surface roughness was observed in mesh handled by a grasper. A ∼25-μm-wide and ∼200-μm-long strap was split on one side from the core of the fiber caused by Cadiere.
  
  
  CONCLUSIONS
  There are morphological changes to polypropylene mesh caused by instrument handling. These changes are different depending on the instrument used. These alterations vary from changes in the surface creating roughness of the fiber, compression of the mesh with narrowing of the fiber in at least one direction or actual splitting or pitting of the fiber. Since there are no data regarding the effect of these morphological changes to the ultimate functioning of the mesh, surgeons should minimize mesh handling by instruments.
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, University of Louisville, Louisville, KY, USA, azadoox@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Azadi
authors.forename: Jacek B
authors.initials: JB
authors.lastname: Jasinski
authors.forename: Sean L
authors.initials: SL
authors.lastname: Francis
authors.forename: Resad
authors.initials: R
authors.lastname: Pasic
authors.forename: Lioudmila
authors.initials: L
authors.lastname: Lipetskaia
authors.forename: Nicolette E
authors.initials: NE
authors.lastname: Deveneau
authors.forename: Taraneh
authors.initials: T
authors.lastname: Yeganeh
authors.forename: Donald R
authors.initials: DR
authors.lastname: Ostergard
mesh_terms: D006801:Humans; D008855:Microscopy, Electron, Scanning; D056887:Pelvic Organ Prolapse / Q000601:surgery; D011126:Polypropylenes; D013499:Surface Properties; D013525:Surgical Instruments; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery
chemical_list: D011126:Polypropylenes