Impact of Thermal Cauterization on the Biomechanical Strength of Mesh Fixation in Porcine Skin and Avian Cartilage Models: Surgical Implications for Sacral Colpopexy

Background: Energy devices are widely used for hemostasis in pelvic reconstructive surgery; however, their thermal effects on tissue integrity at mesh fixation sites remain unclear. This study aimed to investigate the effect of bipolar cauterization on the mechanical strength of mesh fixation. Material and Methods: This experimental ex vivo biomechanical study used porcine skin as a surrogate for the vaginal wall and avian cartilage for the sacral promontory. Polypropylene mesh was sutured to the tissues using 2-0 nonabsorbable sutures (n = 10 per group for each tissue model). The experimental group underwent bipolar cauterization (30 W, 5 s) at the fixation site, whereas no cauterization was performed in the control group. A digital tension device was used to measure tensile strength until fixation failure. The Mann–Whitney U test was used for statistical analysis. Results: Cauterization markedly reduced fixation strength in the porcine skin model (5.1 N vs. 20.5 N, p = 0.0015). Similarly, tensile strength decreased after cauterization in the chicken cartilage model (2.3 N vs. 6.0 N, p = 0.003). Mesh or suture breakage did not occur. Conclusions: Bipolar cauterization markedly weakened the immediate mechanical integrity of mesh anchoring in porcine skin and avian cartilage models. Surgeons should prioritize nonthermal hemostatic methods at intended mesh fixation points to achieve long-lasting apical support.