Cog Threads for Transvaginal Prolapse Repair: Ex-Vivo Studies of a Novel Concept

Round 1

Reviewer 1 Report

Comments are shown in the attached Word document.

Comments for author File: Comments.docx

Author Response

Dear Editor and Reviewers,

Thank you so much for your willingness to give us one more opportunity to publish our findings in journal Surgeries. We are grateful to the Editor and to the Reviewer for the comments/suggestions that allowed us to improve our manuscript entitled: “Cog threads for transvaginal repair of anterior and posterior compartment prolapse: ex-vivo studies of a novel concept”.

All the comments and suggestions were taken into consideration. The authors modelled their replies using a C# for the reviewer questions and an R# to reply to each comment. The original text was modified using track changes. An additional clean copy of the revised manuscript is attached too.

Sincerely yours,

Rita Rynkevic

 

Referee:1

C1: In figure 4, the scale bars are hard to read due to the small font size, the measurements in Figures 4A and 4B are also illegible.

R1: Thank you very much for this note. The quality of the image might get worsened in a word file. We have provided new images, illegible and with better resolution. Also, we have added descriptions of the scale bars and magnitude to the figure legend.

C2: Please discuss the mechanical property of cog threads reinforced vaginal tissue in relation to the maximal pressure in the pelvic region during daily activities.

R2: Thank you for the comment. During different physiological activities, the maximum tensile strength, calculated using Laplace’s Law, might range from 11 to 27 N/cm (Cobb et al., 2005). However, measuring the vagina likely adds unknown pressures from viscera, vaginal smooth muscle, and other unknown sources. For this reason, in our studies, we have mimicked the rectocele (rectum protrusion through the vaginal wall) using a ball burst test of the healthy tissue and reinforced one. Future studies will involve animal models, and intravaginal pressure measurement device developed within the project PRECOGFIL.

Cobb WS, Burns JM, Kercher KW, Matthews BD, James Norton H, Todd Heniford B. “Normal intraabdominal pressure in healthy adults,” J Surg Res. , vol. 129, nº 2, pp. 231-235, 2005.

C3: Can the author advise how long the cog threads are expected to last in the vagina? Please also discuss how the change of mechanical strength (as PCL threads degrade) would affect its ability to support the vaginal tissues.

R3: Thank you for the comment. As described by the provider, the degradation rate of the threads is about two years. They take two to three years to dissolve fully, and results may vary among patients. We will study these questions in the next stage of our investigation, which will be held on animal models (sheep).

C6: In the 5th paragraph in Discussion, there is an extra ‘c’ at the start of the last sentence. Please check for such typos in general.

R6: Thank you for this note. It was a typo error and was corrected.

 

C7: The authors believe that the mechanical support from the cog threads system can be customized to needs by adjusting the number of cogs used. Can the authors also discuss the stress by the threads on vaginal wall and consideration of suitable thread number to avoid vaginal erosion.

R7: Thank you for the comment. Thread lifting is a relatively new procedure. By performing these studies, we obtained the mechanical behaviour of the threads and their immediate reinforcement effect on the vaginal wall. Several variations of the threading technique exist, as the surgeon's preference or to meet specific patient needs. Generally, between 2 and 20 threads might be used for the face lifting procedure. Suitable thread numbers for vaginal reinforcement will be studied on animals in our subsequent investigation.

Author Response File: Author Response.docx

Reviewer 2 Report

interesting article, ok to publish when further discussion of cog threads compared to other methods is expended

Author Response

Dear Editor and Reviewers,

Thank you so much for your willingness to give us one more opportunity to publish our findings in journal Surgeries. We are grateful to the Editor and to the Reviewer for the comments/suggestions that allowed us to improve our manuscript entitled: “Cog threads for transvaginal repair of anterior and posterior compartment prolapse: ex-vivo studies of a novel concept”.

All the comments and suggestions were taken into consideration. The authors modelled their replies using a C# for the reviewer questions and an R# to reply to each comment. The original text was modified using track changes. An additional clean copy of the revised manuscript is attached too.

Sincerely yours,

Rita Rynkevic

 

Referee:2

C1: interesting article, ok to publish when further discussion of cog threads compared to other methods is expended.

R1: Thank you very much for the comment. Other methods of prolapse treatment and their limitations are described/discussed in the introduction. A comparison of the positive qualities of the proposed method and the disadvantages of the previously mentioned are expanded in the discussion.

Author Response File: Author Response.docx