@article{BhattaraiMayStaatetal.2022, author = {Bhattarai, Aroj and May, Charlotte Anabell and Staat, Manfred and Kowalczyk, Wojciech and Tran, Thanh Ngoc}, title = {Layer-specific damage modeling of porcine large intestine under biaxial tension}, series = {Bioengineering}, volume = {9}, journal = {Bioengineering}, number = {10, Early Access}, publisher = {MDPI}, address = {Basel}, issn = {2306-5354}, doi = {10.3390/bioengineering9100528}, pages = {1 -- 17}, year = {2022}, abstract = {The mechanical behavior of the large intestine beyond the ultimate stress has never been investigated. Stretching beyond the ultimate stress may drastically impair the tissue microstructure, which consequently weakens its healthy state functions of absorption, temporary storage, and transportation for defecation. Due to closely similar microstructure and function with humans, biaxial tensile experiments on the porcine large intestine have been performed in this study. In this paper, we report hyperelastic characterization of the large intestine based on experiments in 102 specimens. We also report the theoretical analysis of the experimental results, including an exponential damage evolution function. The fracture energies and the threshold stresses are set as damage material parameters for the longitudinal muscular, the circumferential muscular and the submucosal collagenous layers. A biaxial tensile simulation of a linear brick element has been performed to validate the applicability of the estimated material parameters. The model successfully simulates the biomechanical response of the large intestine under physiological and non-physiological loads.}, language = {en} } @article{BhattaraiHorbachStaatetal.2022, author = {Bhattarai, Aroj and Horbach, Andreas and Staat, Manfred and Kowalczyk, Wojciech and Tran, Thanh Ngoc}, title = {Virgin passive colon biomechanics and a literature review of active contraction constitutive models}, series = {Biomechanics}, volume = {2}, journal = {Biomechanics}, number = {2}, publisher = {MDPI}, address = {Basel}, issn = {2673-7078}, doi = {10.3390/biomechanics2020013}, pages = {138 -- 157}, year = {2022}, abstract = {The objective of this paper is to present our findings on the biomechanical aspects of the virgin passive anisotropic hyperelasticity of the porcine colon based on equibiaxial tensile experiments. Firstly, the characterization of the intestine tissues is discussed for a nearly incompressible hyperelastic fiber-reinforced Holzapfel-Gasser-Ogden constitutive model in virgin passive loading conditions. The stability of the evaluated material parameters is checked for the polyconvexity of the adopted strain energy function using positive eigenvalue constraints of the Hessian matrix with MATLAB. The constitutive material description of the intestine with two collagen fibers in the submucosal and muscular layer each has been implemented in the FORTRAN platform of the commercial finite element software LS-DYNA, and two equibiaxial tensile simulations are presented to validate the results with the optical strain images obtained from the experiments. Furthermore, this paper also reviews the existing models of the active smooth muscle cells, but these models have not been computationally studied here. The review part shows that the constitutive models originally developed for the active contraction of skeletal muscle based on Hill's three-element model, Murphy's four-state cross-bridge chemical kinetic model and Huxley's sliding-filament hypothesis, which are mainly used for arteries, are appropriate for numerical contraction numerical analysis of the large intestine.}, language = {en} } @phdthesis{Bhattarai2018, author = {Bhattarai, Aroj}, title = {Constitutive modeling of female pelvic floor dysfunctions and reconstructive surgeries using prosthetic mesh implants}, isbn = {978-3-9818074-8-6}, doi = {10.17185/duepublico/70340}, pages = {192 S.}, year = {2018}, language = {en} } @article{BhattaraiStaat2019, author = {Bhattarai, Aroj and Staat, Manfred}, title = {A computational study of organ relocation after laparoscopic pectopexy to repair posthysterectomy vaginal vault prolapse}, series = {Computer Methods in Biomechanics and Biomedical Engineering: Imaging \& Visualization}, journal = {Computer Methods in Biomechanics and Biomedical Engineering: Imaging \& Visualization}, publisher = {Taylor \& Francis}, address = {London}, issn = {2168-1171}, doi = {10.1080/21681163.2019.1670095}, year = {2019}, language = {en} } @techreport{BhattaraiFrotscherDurongetal.2016, author = {Bhattarai, Aroj and Frotscher, Ralf and Durong, Minh Tu{\´a}n and Staat, Manfred}, title = {Schlussbericht zu BINGO. Optimierung des Systems Netzimplantat-Beckenboden zur therapeutischen Gewebeverst{\"a}rkung nach der Integraltheorie.}, address = {Aachen}, pages = {34}, year = {2016}, language = {de} } @article{BhattaraiStaat2018, author = {Bhattarai, Aroj and Staat, Manfred}, title = {Computational comparison of different textile implants to correct apical prolapse in females}, series = {Current Directions in Biomedical Engineering}, volume = {4}, journal = {Current Directions in Biomedical Engineering}, number = {1}, publisher = {De Gruyter}, address = {Berlin}, doi = {10.1515/cdbme-2018-0159}, pages = {661 -- 664}, year = {2018}, abstract = {Prosthetic textile implants of different shapes, sizes and polymers are used to correct the apical prolapse after hysterectomy (removal of the uterus). The selection of the implant before or during minimally invasive surgery depends on the patient's anatomical defect, intended function after reconstruction and most importantly the surgeon's preference. Weakness or damage of the supporting tissues during childbirth, menopause or previous pelvic surgeries may put females in higher risk of prolapse. Numerical simulations of reconstructed pelvic floor with weakened tissues and organ supported by textile product models: DynaMesh®-PRS soft, DynaMesh®-PRP soft and DynaMesh®-CESA from FEG Textiletechnik mbH, Germany are compared.}, language = {en} } @incollection{BhattaraiStaat2018, author = {Bhattarai, Aroj and Staat, Manfred}, title = {Mechanics of soft tissue reactions to textile mesh implants}, series = {Biological, Physical and Technical Basics of Cell Engineering}, booktitle = {Biological, Physical and Technical Basics of Cell Engineering}, editor = {Artmann, Gerhard and Temiz Artmann, Ayseg{\"u}l and Zhubanova, Azhar A. and Digel, Ilya}, publisher = {Springer}, address = {Singapore}, isbn = {978-981-10-7904-7}, doi = {10.1007/978-981-10-7904-7_11}, pages = {251 -- 275}, year = {2018}, abstract = {For pelvic floor disorders that cannot be treated with non-surgical procedures, minimally invasive surgery has become a more frequent and safer repair procedure. More than 20 million prosthetic meshes are implanted each year worldwide. The simple selection of a single synthetic mesh construction for any level and type of pelvic floor dysfunctions without adopting the design to specific requirements increase the risks for mesh related complications. Adverse events are closely related to chronic foreign body reaction, with enhanced formation of scar tissue around the surgical meshes, manifested as pain, mesh erosion in adjacent structures (with organ tissue cut), mesh shrinkage, mesh rejection and eventually recurrence. Such events, especially scar formation depend on effective porosity of the mesh, which decreases discontinuously at a critical stretch when pore areas decrease making the surgical reconstruction ineffective that further augments the re-operation costs. The extent of fibrotic reaction is increased with higher amount of foreign body material, larger surface, small pore size or with inadequate textile elasticity. Standardized studies of different meshes are essential to evaluate influencing factors for the failure and success of the reconstruction. Measurements of elasticity and tensile strength have to consider the mesh anisotropy as result of the textile structure. An appropriate mesh then should show some integration with limited scar reaction and preserved pores that are filled with local fat tissue. This chapter reviews various tissue reactions to different monofilament mesh implants that are used for incontinence and hernia repairs and study their mechanical behavior. This helps to predict the functional and biological outcomes after tissue reinforcement with meshes and permits further optimization of the meshes for the specific indications to improve the success of the surgical treatment.}, language = {en} } @inproceedings{BhattaraiStaat2018, author = {Bhattarai, Aroj and Staat, Manfred}, title = {Pectopexy to repair vaginal vault prolapse: a finite element approach}, series = {Proceedings CMBBE 2018}, booktitle = {Proceedings CMBBE 2018}, editor = {Fernandes, P.R. and Tavares, J. M.}, year = {2018}, abstract = {The vaginal prolapse after hysterectomy (removal of the uterus) is often associated with the prolapse of the vaginal vault, rectum, bladder, urethra or small bowel. Minimally invasive surgery such as laparoscopic sacrocolpopexy and pectopexy are widely performed for the treatment of the vaginal prolapse with weakly supported vaginal vault after hysterectomy using prosthetic mesh implants to support (or strengthen) lax apical ligaments. Implants of different shape, size and polymers are selected depending on the patient's anatomy and the surgeon's preference. In this computational study on pectopexy, DynaMesh®-PRP soft, GYNECARE GYNEMESH® PS Nonabsorbable PROLENE® soft and Ultrapro® are tested in a 3D finite element model of the female pelvic floor. The mesh model is implanted into the extraperitoneal space and sutured to the vaginal stump with a bilateral fixation to the iliopectineal ligament at both sides. Numerical simulations are conducted at rest, after surgery and during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues and prosthetic meshes are modeled as incompressible, isotropic hyperelastic materials. The positions of the organs are calculated with respect to the pubococcygeal line (PCL) for female pelvic floor at rest, after repair and during Valsalva maneuver using the three meshes.}, language = {en} } @article{BhattaraiJabbariAndingetal.2018, author = {Bhattarai, Aroj and Jabbari, Medisa and Anding, Ralf and Staat, Manfred}, title = {Surgical treatment of vaginal vault prolapse using different prosthetic mesh implants: a finite element analysis}, series = {tm - Technisches Messen}, volume = {85}, journal = {tm - Technisches Messen}, number = {5}, publisher = {De Gruyter}, address = {Berlin}, issn = {2196-7113}, doi = {10.1515/teme-2017-0115}, pages = {331 -- 342}, year = {2018}, abstract = {Particularly multiparous elderly women may suffer from vaginal vault prolapse after hysterectomy due to weak support from lax apical ligaments. A decreased amount of estrogen and progesterone in older age is assumed to remodel the collagen thereby reducing tissue stiffness. Sacrocolpopexy is either performed as open or laparoscopic surgery using prosthetic mesh implants to substitute lax ligaments. Y-shaped mesh models (DynaMesh, Gynemesh, and Ultrapro) are implanted in a 3D female pelvic floor finite element model in the extraperitoneal space from the vaginal cuff to the first sacral (S1) bone below promontory. Numerical simulations are conducted during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues are modeled as incompressible, isotropic hyperelastic materials whereas the meshes are modeled either as orthotropic linear elastic or as isotropic hyperlastic materials. The positions of the vaginal cuff and the bladder base are calculated from the pubococcygeal line for female pelvic floor at rest, for prolapse and after repair using the three meshes. Due to mesh mechanics and mesh pore deformation along the loaded direction, the DynaMesh with regular rectangular mesh pores is found to provide better mechanical support to the organs than the Gynemesh and the Ultrapro with irregular hexagonal mesh pores. Insbesondere {\"a}ltere, mehrgeb{\"a}hrende Frauen leiden h{\"a}ufiger an einem Scheidenvorfall nach einer Hysterektomie aufgrund der schwachen Unterst{\"u}tzung durch laxe apikale B{\"a}nder. Es wird angenommen, dass eine verringerte Menge an {\"O}strogen und Progesteron im h{\"o}heren Alter das Kollagen umformt, wodurch die Gewebesteifigkeit reduziert wird. Die Sakrokolpopexie ist eine offene oder laparoskopische Operation, die mit prothetischen Netzimplantaten durchgef{\"u}hrt wird, um laxe B{\"a}nder zu ersetzen. Y-f{\"o}rmige Netzmodelle (DynaMesh, Gynemesh und Ultrapro) werden in einem 3D-Modell des weiblichen Beckenbodens im extraperitonealen Raum vom Vaginalstumpf bis zum Promontorium implantiert. Numerische Simulationen werden w{\"a}hrend des Valsalva-Man{\"o}vers mit geschw{\"a}chtem Gewebe durchgef{\"u}hrt, das durch eine reduzierte Gewebesteifigkeit modelliert wird. Die Gewebe werden als inkompressible, isotrop hyperelastische Materialien modelliert, w{\"a}hrend die Netze entweder als orthotrope linear elastische oder als isotrope hyperlastische Materialien modelliert werden. Die Positionen des Vaginalstumpfs, der Blase und der Harnr{\"o}hrenachse werden anhand der Pubococcygeallinie aus der Ruhelage, f{\"u}r den Prolaps und nach der Reparatur unter Verwendung der drei Netze berechnet. Aufgrund der Netzmechanik und der Netzporenverformung bietet das DynaMesh mit regelm{\"a}ßigen rechteckigen Netzporen eine bessere mechanische Unterst{\"u}tzung und eine Neupositionierung des Scheidengew{\"o}lbes, der Blase und der Urethraachse als Gynemesh und Ultrapro mit unregelm{\"a}ßigen hexagonalen Netzporen.}, language = {en} } @article{BhattaraiStaat2018, author = {Bhattarai, Aroj and Staat, Manfred}, title = {Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions}, series = {Computational and Mathematical Methods in Medicine}, volume = {2018}, journal = {Computational and Mathematical Methods in Medicine}, number = {Article ID 9518076}, publisher = {Hindawi}, address = {New York, NY}, issn = {1748-6718}, doi = {10.1155/2018/9518076}, pages = {1 -- 16}, year = {2018}, abstract = {After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5\%), adipose tissue (85\%), and smooth muscle (5\%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.}, language = {en} }