The US Food and Drug Administration recently warned about the risks associated with using robotic devices during mastectomies and other cancer surgeries. The agency is cautioning that these devices may increase health safety risks, and they could even result in poor surgery outcomes for patients.
The new report is based on the agency’s review of recent studies that suggest that robotic surgical devices may not be entirely safe and effective. The warning says that the data on the risks of these robotic surgery tools, when used in cancer procures, is very limited. The agency also emphasized that it cannot verify how effective these tools actually are.
Recent studies have been questioning the effectiveness of using robotic tools in cancer procedures. For example, a recent study in the New England Journal of Medicine linked the use of these devices in cervical cancer surgeries with a lower disease-free survival rate, as well as an overall post-operation survival rate, when compared with traditional surgery techniques.
Robotically-assisted surgery has been on the rise in recent years, as new technology has emerged to assist surgeons in a variety of procedures. The robots make tiny and very precise incisions—more precise than can typically be made by a surgeon’s hand—which can aid in the patient’s recovery, and help reduce pain, scarring and the risk of infection. The FDA confirms, too, that patient recovery time is quicker when using robotic surgery devices, in comparison to traditional surgical techniques.
But the FDA says it’s worried that surgeons, health care providers and patients may not be fully aware that the safety and effectiveness of these devices in mastectomy procedures has not been established. Nor is there sufficient data regarding the safety and effectiveness in using robotic devices in surgeries intended to treat or prevent cancer. The agency cited peer-reviewed journal studies, including the study in the New England Journal of Medicine, that show that the minimally invasive robotic surgery actually had a lower survival rate than traditional, open-abdomen surgery in hysterectomy procedures to treat patients with cervical cancer.
Because of the lack of data and the studies suggesting lower survival rates with surgeries using these devices, the FDA has refused to grant marketing clearance for any robotically-assisted medical devices for the prevention or treatment of cancer—and in particular, breast cancer. Additionally, any robotic surgical devices sold in the United States must include a warning label that states that cancer treatment outcomes when using this device have not been fully evaluated by the FDA.
In issuing its warning, the FDA emphasized that it takes women’s health issues very seriously. Therefore, the agency believes that this safety warning communication was necessary to help doctors and patients understand that these devices have not been fully vetted by the medical community. The agency is emphasizing that more studies are needed to collect more data on patient survival rate, patient post-operative health, and the risks and benefits associated with these devices. In the meantime, the agency is encouraging patients, health care providers, and patient caregivers to discuss all the risks and benefits associated with these robotic devices before making a decision regarding their surgery procedure. Patients should also talk about alternatives to robotic operations with their doctors before making a decision. Finally, before committing to a robotically-assisted cancer surgery, patients should question their surgeon about his or her level of training, experience in robotic surgery, and outcomes of the patients he or she has treated with robotically-assisted surgery.
Hernia Mesh Defective Products Cause Lifelong Complications
Hernia mesh products have been around since the 1950s when they were first developed. They have become widely accepted as a method to repair hernias. Over time, manufacturers have altered these products with new materials, various coatings and unique features. Some of the mesh products have been proven to be defective, even to the point of causing life-changing injuries.
Multiple Defective Products
Even though hernia mesh products have been around for decades, new products are continually being introduced and not all of them are safe. Some of these products contain different materials and have not been tested thoroughly to determine safety. Often, additional surgery is required to remove the mesh and to repair the hernia again that the first mesh failed to treat.
Some of the products involved in lawsuits include the following:
- Covidien – one of the most recognizable names, Covidien has had numerous claims against its products. Parietex hernia mesh was one product that used the material polyester rather than polypropylene. While it tried to fix the problems associated with this product, it did not test the safety of the mesh before putting it on the market.
- Bard – another well-known name, Bard has a product called Sepramesh IP Composite, which is supposed to incorporate itself into the tissue and is made with polyglycolic acid and polypropylene. It is used in reconstructing soft tissue loss, but has been associated with serious side effects, including bowel obstruction and adhesions, which often require surgeries to correct.
- Ethicon – the Ethicon Physiomesh was approved by the Food and Drug Administration (FDA) in April 2010 and launched as a product in October 2010. However, it was taken off the market voluntarily because of issues with the base layer, which is made of polypropylene. This plastic material is coated with polymeric films which is supposed to cause the material to degrade, but it often remains in the person’s body for a long time.
- Atrium – The Atrium C-QUR was approved for use by the FDA in March 2006, but it has been associated with problems. Two versions, one used for pre-peritoneal repairs and another with placement in the intra-abdominal area, were designed for small hernia issues.
Complications from Hernia Mesh Products
Hernia mesh products can cause a wide range of side effects. The most minor include severe pain, but most require surgery to fix the problem. The most common complications from this product is also the most serious. Adhesion and bowel obstruction are common along with the risk of rejection, migration and infection.
One of the most common complications is adhesion which causes scar-like tissue to stick together and results in chronic pain that may be severe. It can lead to bowel obstruction which can be life-threatening.
In one case, a hernia mesh product attached to the small intestine of a patient. It was necessary to remove the mesh just 12 days after the original surgery to implant it. The mesh products are usually coated to prevent the risk of adhesion, but the coating is dissolved in the body in a short time, which then allows the product to adhere to the intestines or other tissue.
The mesh can also migrate to other areas of the body, where it can cause other issues. One of the most severe and dangerous complications is bowel obstruction. The person begins to feel nauseated and vomits and is unable to pass stool or even gas. Treatment is necessary immediately or the person can die. The obstruction will cut off blood flow if not treated quickly, which will allow part of the intestine to die and need to be removed. According to the FDA, a major reason for bowel obstruction is due to recalled mesh.
Bowel perforation is another serious condition which happens from hernia mesh. It occurs when the product punctures the bowel. The mesh can also perforate other organs or the abdominal wall. Symptoms include nausea and vomiting, severe pain in the abdomen and rigidity. Bacteria gets into the abdominal cavity and leads to peritonitis or sepsis and requires immediate medical attention.
These and other complications may occur right away after the initial surgery. However, it can also be years before a person experiences the complications. With the longer wait, it can take some time to realize the direct cause is the hernia mesh. Lawsuits have been filed for hernia mesh complications that resulted from recalled products or those that have been deemed to be defective. The cost of repair can be quite a financial burden with multiple surgeries and even permanent damage.
Complications from Hernia Mesh
Hernia mesh products have been around and used in hernia repair surgeries since they were first introduced in the 1950s. However, they have not been without some serious complications, which can even be life-threatening. While there are risks for any hernia repair surgery, some of the most common and most serious have resulted from mesh products that have been recalled.
Adhesion from Hernia Mesh Products
One of the most common issues is adhesion from the mesh implanted in the abdomen of the patient. Hernia mesh products are made of a variety of materials, and they may attach to tissue inside. The mesh has a coating which helps prevent the issue, but the coating dissolves while the mesh is often permanent.
The mesh may adhere to the abdominal wall or the intestines or other tissue. It can cause severe pain that won’t go away until the product is removed through surgery. Adhesion can lead to bowel obstruction.
Bowel Obstruction with Hernia Mesh
A bowel obstruction begins with an adhesion to the intestines. It can also migrate where it can entrap the intestines. Symptoms of bowel obstruction include nausea and vomiting. The patient is also unable to pass stool. They will require immediate attention because this is a dangerous condition.
If not treated quickly enough, part of the intestine may need to be removed. Reports from the FDA cite mesh products that have been recalled as a major reason for obstruction.
How Hernia Mesh Causes Bowel Perforation
Recalled products have also been shown to cause perforation in the bowels. This occurs when the mesh punctures the intestine or other area of the abdomen. It may also puncture an organ, creating a life-threatening condition.
Symptoms of a bowel perforation include nausea and vomiting along with severe pain in the abdomen and rigidity of the abdomen – the abdomen feels hard. Bacteria can get into the abdomen from the puncture, which can then lead to sepsis and peritonitis. These conditions may be fatal.
Infection from Hernia Mesh
An infection may result from hernia mesh surgery. Often, the mesh will need to be removed through surgery. Antibiotics can treat minor issues while deep infections are more complicated. Chronic infection may not begin for years after the initial surgery, which can make it more difficult to diagnose.
A person with infection from a hernia mesh product may experience inflammation and fever. They may notice other flu-like symptoms as well.
Migration of the Hernia Mesh
Another complication for hernia mesh surgery is that the product will detach and migrate into other areas of the body. Complications from a migrating mesh can include the following:
- Bowel obstruction
- Bowel perforation
In one case reported to the FDA, an implant detached and migrated to the intestine where it adhered. Surgery was required to remove the mesh along with a portion of the intestine.
There may be pain with migration or the patient may not have any symptoms until other damage occurs.
The hernia mesh product may rip, tear or disintegrate, causing problems. The mesh can rip from the sutures, which often happens if the person lifts something too heavy or overexerts themselves too soon after surgery.
Another issue is if the mesh shrinks, which can cause it to come lose from the sutures in time. A long-term issue is when the mesh erodes and breaks into pieces. The pieces may move around and perforate surrounding tissue.
All of these problems can lead to migration, which can cause other complications. Surgery is often necessary to repair the condition.
Issues with hernia mesh can happen right after surgery, a few weeks or months later or years afterwards. The hernia may rupture again even with the mesh in place. While the product is effective at repairing the hernia, it is not a guarantee.
As with any surgical procedure, there is a risk of these complications even if everything is done correctly. However, there have been numerous recalls of hernia mesh products that increase the risk of problems. It may be related to the materials used or the design of the product. Some products have a higher failure rate than others, and some have been recalled due to their safety issues.
It is important to let a doctor know you’ve had a hernia mesh if you experience symptoms that can be associated with these complications. Often, immediate medical attention is necessary to prevent further damage or health issues. It can be difficult to diagnose a condition related to the mesh correctly.
Hernia Mesh Injuries Result in Lawsuits
Many people who have had hernias needed surgery to fix the problem using a hernia mesh. These products come with side effects, including infection, adhesion and a reaction to the mesh. However, some products have a defective design which causes them to not function properly. When this is the case, the injury often turns into a lawsuit.
Defects in the Devices
When a lawsuit is filed, the attorneys for the plaintiffs argue that the devices were designed incorrectly or not tested to ensure safety. The main issues with the hernia mesh includes using the wrong material. The materials used often:
- Shrink or contract
The results from a defective mesh can include damage to the bowels or abdominal wall, damage to other organs and nerve damage. Often additional surgeries are necessary to correct the problem.
Another issue with hernia mesh devices is they have been marketed for uses for which they aren’t necessary. For example, they may be used in small hernias that would otherwise use laparoscopic treatment or stitches.
The challenge of the court is to determine if the injuries that occurred would not have occurred with a substitute product or another treatment option.
Injuries and Side Effects from Hernia Mesh
When the hernia is located in the abdominal wall, surgery is often necessary to correct the condition. Smaller hernias in this area can often be repaired with a different material for the mesh or without the use of a mesh device.
Synthetic mesh products pose a higher risk than biologic devices, and many of these products are taken to market quickly through a clearance process by the Food and Drug Administration called 510K. Numerous devices have been recalled.
There are hidden results that many patients aren’t aware of. They include the following:
- Coatings which are used on the mesh device and may cause a reaction in the patient or infection
- The mesh shrinks or hardens
- The mesh may detach and migrate to a different area
- Reaction to a foreign body or rejection of the device
Common side effects for patients who receive a hernia mesh include:
- Obstructions in the intestines
- Adhesions to tissue
- Permanent nerve damage
- Recurrence of the hernia
Many times, the patient must undergo revision surgery to correct the resulting conditions and remove the mesh or replace it.
Risks of Using Hernia Mesh over Stitches
A hernia mesh is often used in surgery where stitches would work as well. The risk of choosing the mesh is the device can shrink or move over time. This situation can lead to perforations in the bowel or other organs as well as obstruction in the bowel. The risks increase if the device is faulty or if it uses polypropylene as a coating.
If the bowel is perforated, bacteria can seep into the bloodstream or other areas and cause sepsis, which can be a fatal disease.
Symptoms of complications from a hernia mesh include:
- Irritable bowels
- Severe pain
- Urinary problems
- Abdominal pain
Complications can occur immediately following the procedure or within a few days. They can also take years to show up when the mesh device falls apart or causes a problem.
While there is risk involved with hernia surgery and complications can arise, they are often increased with a defective device. The product should be labeled properly with the risks and warnings clearly stated.
Multiple Devices Recalled
Numerous mesh devices from different manufacturers have been recalled. For instance, Johnson & Johnson recalled the Physiomesh, manufactured by the subsidiary Ethicon. Studies revealed a higher rate for revision surgeries with the use of this device for minor hernia repairs.
Covidien is another manufacturer that has been involved in settlement discussions for its products. One issue was with the Parietex product, which used polyester as the material instead of polypropylene. Tests were not conducted to test the safety of the product before it went on the market.
Bard has also been involved in hernia mesh issues with the Sepramesh IP Composite product, which is used in deficiency of soft tissue. It has been associated with bowel obstruction and adhesions.
Atrium C-QUR is another device that was used in small hernia repairs but has had some issues. There are two products in this line. One was for pre-peritoneal hernias and the other was for intra-abdominal repairs.
Hernia mesh products have not always been effective and may even cause more problems than what they were intended to cure. Numerous patients have suffered pain and required multiple surgeries to fix the problem caused by defective products.
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