Hernia repair, revolutionized

January 9, 2013 by Angela Herring
Fifth year mechanical engineering students Joseph Aaron, Andrew Edgerly, Charles O’Connell, Charles Sidoti, and David Stone developed a delivery device for hernia mesh surgeries. Credit: Brooks Canaday

Each year, more than one mil­lion patients in the U.S. undergo hernia repair surgery, the most common form of which takes place in the abdomen. The injury presents itself as a weak­ness in the abdom­inal wall until ulti­mately the tissue gives way, leaving an open hole.

In the most effec­tive form of surgery, the sur­geon lays a piece of mesh over the hole and secures it in place with bio-​​absorbable fas­teners. But the devices for deliv­ering these fas­teners are expen­sive, forcing some clin­i­cians to choose alter­na­tive, per­haps less ideal methods.

Under the direc­tion of engi­neering pro­fessor Jef­frey Ruberti, how­ever, a team of stu­dents devel­oped a reli­able and cost-​​effective new device to secure the fas­teners in place. The project was one of two win­ners in last semester's mechan­ical engi­neering Cap­stone competition.

A close-​​up of existing (first three items) sur­gical mesh fas­teners and a mockup of the helical fas­tener (right) devel­oped by High Road Med­ical. Credit: Brooks Canaday

While working on co-​​op last spring at a med­ical device com­pany called MoMelan, team member Charles Sidoti met North­eastern alumnus Jeff Cerier. In Feb­ruary of 2011, Cerier and his busi­ness part­ners estab­lished High Road Med­ical, which is devoted to devel­oping improved devices for cur­rent sur­gical and endo­scopic pro­ce­dures, with a focus on improving ease-​​of-​​use and lower per-​​procedure costs. Cerier and his team pre­sented the North­eastern group with a straight­for­ward chal­lenge: to develop a device for High Road's unique fas­tener design.

Sidoti and his fellow student-​​researchers Joseph Aaron, Andrew Edgerly, Charles O'Connell, and David Stone, designed and con­structed two reusable instru­ments, which they call the Tip Drive model and the Threaded Rotator model. The first uses both rota­tion and trans­la­tion to intro­duce the fas­tener; the latter is based entirely on rota­tion. Each has its own set of pros and cons, the stu­dents explained, but they all agreed the Tip Drive is a more robust design.

A novel rotary drive pro­vides tac­tile feed­back to sur­geons per­forming laparo­scopic surgery. Credit: Brooks Canaday

Mem­bers of the group also met with a sur­geon at Mass­a­chu­setts Gen­eral Hos­pital to get an insider per­spec­tive on the industry stan­dard. "He said he hates all the devices on the market," said Aaron. "They feel flimsy and give no tac­tile feedback."

Cur­rently, sur­geons may think the fas­tener is prop­erly aligned, but won't know for sure until they deploy it. If not prop­erly aligned, fas­teners can drop into the abdom­inal cavity, intro­ducing more complications.

There­fore, in addi­tion to simply designing a reli­able device, mem­bers of the team decided to incor­po­rate a fea­ture that uses a novel force-​​amplification method to help sur­geons during the pro­ce­dure. The ampli­fier makes it pos­sible for users to feel the fas­tener coming into con­tact with a surface.

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