Evaluation of Dehydrated Human Amnion/Chorion Membrane as an Adhesion Barrier in Women Undergoing Robotic Laparoscopy

Abstract

Introduction: Amniotic membrane contains collagen, cytokines and growth factors, is immune privileged, and has been shown to modulate inflammation and reduce scarring. Dehydrated human amnion/chorion membrane (dHACM) allografts have been used in many clinical and surgical applications to facilitate healing. We describe our experience of using commercially available dHACM allograft as an adhesion barrier in women undergoing da Vinci robot laparoscopy at an outpatient surgery center. Methods: With IRB permission, we conducted a retrospective evaluation of medical records from 16 consecutive patients that had undergone robotic laparoscopy for pelvic pain due to endometriosis and adhesions. All patients had resection of endometriosis and adhesiolysis with application of dHACM. As per our routine practice, all had been scheduled for a second surgery to inspect for reformation of adhesions, and to lyse any additional adhesions found. Results: We found handling characteristics of dHACM to be suitable for the microsurgery environment, although care needed to be taken to avoid fraying or breaking the material as it was introduced through the trocar. Fifteen of 16 patients receiving dHACM had a second procedure 1-2 weeks later. In 14 of the 15 cases, no new adhesions were observed in areas where dHACM was placed. No adverse events or major complications had been recorded in the medical record. Discussion: The biologic properties of dHACM give rise to its use in a wide variety of clinical applications. Our experience demonstrates that using dHACM as an adhesion barrier is feasible in women undergoing da Vinci robot laparoscopy.