{"id":272016,"date":"2024-07-12T10:45:18","date_gmt":"2024-07-12T08:45:18","guid":{"rendered":"https:\/\/www.matachana.com\/?p=272016"},"modified":"2026-03-25T08:23:27","modified_gmt":"2026-03-25T07:23:27","slug":"reprocessing-laparoscopy-using-low-temperature-sterilizationvh2o2-or-ltsf","status":"publish","type":"post","link":"https:\/\/www.matachana.com\/en\/reprocessing-laparoscopy-using-low-temperature-sterilizationvh2o2-or-ltsf\/","title":{"rendered":"REPROCESSING LAPAROSCOPY USING  LOW TEMPERATURE STERILIZATION\u2026VH2O2 or LTSF?"},"content":{"rendered":"<h3>Comparison in terms of gentleness &amp; ease of use with medical devices<\/h3>\n<p>&nbsp;<\/p>\n<hr size=\"2px\" \/>\n<p><strong>Authors:<\/strong> Dr. Daniel V\u00e1zquez<strong><sup>1<\/sup><\/strong>; Dr. Nelson Carreras<strong><sup>2<\/sup><\/strong>; Dr. Alex Zamora<strong><sup>3<\/sup><\/strong>; Ing. Alejandro Ram\u00edrez<strong><sup>4<\/sup><\/strong>. <strong><sup>1<\/sup><\/strong>Matachana Test Center Coordinator, <strong><sup>2<\/sup><\/strong>Global Product Manager Consumables, <strong><sup>3<\/sup><\/strong>RDI Chemist,<sup> <strong>4<\/strong><\/sup>Global Product Manager Low Temperature Sterilizers. <strong>Abbreviations:<\/strong> VH202 \u2013 Vaporized Hydrogen Peroxide, LTSF \u2013 Low Temperature Steam and Formaldehyde, RMD \u2013 Reprocessable Medical Device, PCD \u2013 Process Challenge Device<\/p>\n<hr size=\"2px\" \/>\n<h2>\u00a0<\/h2>\n<h3><strong>WFHSS-GUIDELINES<\/strong><\/h3>\n<p>According to WFHSS-Guidelines \u201c<em>heat sensitive RMD\u2019s require a range of cycles adapted to their material and geometrical specificities. Some heat compatible, minimally invasive surgery instruments are subject to accelerated aging (e.g., laparoscopy devices). Some countries offer the flexibility to use low temperature sterilization; other countries do not\u201d. <\/em><strong><sup>[1]<\/sup><\/strong><\/p>\n<table style=\"border: hidden;\">\n<tbody style=\"border: hidden; background-color: rgba(242,243,244,1.00);\">\n<tr style=\"border: hidden;\">\n<td style=\"border: hidden; text-align: justify;\">BUT IF WE DECIDE TO TERMINALLY STERILIZE LAPAROSCOPY DEVICES USING A LOW TEMPERATURE METHOD, WHICH IS THE GENTLEST TECHNOLOGY WITH THE MEDICAL DEVICES? VH2O2 OR LTSF?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>\u00a0<\/h2>\n<h3><strong>THE EFFECT OF FORMALDEHYDE AGAINST MICROBIAL PROTEIN<\/strong><\/h3>\n<p>In solution, formaldehyde can be found in various forms, bounded\u00a0to water molecules. We can find monomeric (monohydrate) species known as <strong>methylene glycols<\/strong> and polymeric (polyhydrated) species named <strong>polyoxymethylene glycols<\/strong> in the formaldehyde solution. At room temperature and low concentrations, the monomer\/polymer solution ratio is 1:1200, in accordance with data from various\u00a0studies. <strong><sup>[2-6]<\/sup><\/strong><\/p>\n<p>In addition, polyoxymethylenes can consist of various numbers of glycol groups:<\/p>\n<ul>\n<li>CH<sub>2<\/sub>O &#8211; formaldehyde<\/li>\n<li>CH<sub>2<\/sub>(OH)<sub>2<\/sub> &#8211; methylene glycol, formed by adding a water molecule<\/li>\n<li>(CH<sub>2<\/sub>O)<sub>3<\/sub> &#8211; trioxymethylene glycol or paraformaldehyde<\/li>\n<li>(CH<sub>2<\/sub>O)<sub>n<\/sub> &#8211; different polyoxymethylene glycols<\/li>\n<\/ul>\n<p>These polymeric species can polymerize to form a white precipitate depending on temperature and concentration. In the <em>e-bag<\/em><sup>\u00ae<\/sup> solution, ethanol serves to stabilize formaldehyde and prevent its polymerization, thereby avoiding the formation of precipitates. <strong><sup>[7-9]<\/sup><\/strong><\/p>\n<p>Formaldehyde is stable in its gaseous state, and its biocidal activity originates from its ability to interact with amino groups from proteins and nucleic acids, as illustrated in Figure 1. Its carboxyl group is highly reactive and interacts with proteins and nucleic acids, conferring it broad-spectrum effectiveness against microorganisms. <strong><sup>[10]<\/sup><\/strong><\/p>\n<h4><strong>Microbicidal mechanism:<\/strong><\/h4>\n<p>Formaldehyde\u2019s aldehyde group cross-links membrane proteins, <strong>denaturing<\/strong> them and also damages DNA and RNA, disrupting cellular function and leading to microorganism death. <strong><sup>[11-12]<\/sup><\/strong><\/p>\n<p><img decoding=\"async\" src=\"https:\/\/www.matachana.com\/wp-content\/uploads\/2024\/07\/MATACHANA_BLOG_Instrumental_LAPAROSCOPIO_03.jpg\" width=\"1000\" \/><\/p>\n<p>Figure 1. Cross link and formation of methylene bridges by formaldehyde between (A) proteins and (B) proteins and nucleic acids.<sup> [17]<\/sup><\/p>\n<h3><strong>THE EFFECT OF VH2O2 AGAINST MICROORGANISMS<\/strong><\/h3>\n<p>Vaporized Hydrogen Peroxide (VH2O2) is a highly oxidizing substance and its active derivatives produced after decomposition have strong oxidation effects which directly disrupt the cell cytomembranes of microorganisms. However, this powerful oxidative action can also impact the materials used in medical devices, potentially leading to issues such as corrosion or gradual material degradation over time. <strong><sup>[13]<\/sup><\/strong><\/p>\n<table style=\"border: hidden;\">\n<tbody style=\"border: hidden; background-color: rgba(242,243,244,1.00);\">\n<tr style=\"border: hidden;\">\n<td style=\"border: hidden; text-align: justify;\">WE\u2019VE SEEN THAN LTSF IS THE GENTLEST TECHNOLOGY, BUT WHICH IS THE EASIEST TECHNOLOGY TO OPERATE?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Loading the sterilizer is a crucial step during the terminal sterilization process. After washing, inspecting, assembling (if required), drying and packing\/pouching the laparoscopic devices, we\u2019ll need to properly load the sterilizer according to the specification of the sterilization program selected. \u00a0\u00a0Proper loading process following the sterilizer\u2019s Instructions For Use, will ensure that after selecting the load-related sterilization program, the sterilization conditions on the load will be achieved.<\/p>\n<p>In this regards, VH2O2 sterilizers are known for their complexity during the loading chamber process.\u00a0 In general, the <strong>maximum length<\/strong> and <strong>minimum internal diameter<\/strong> of each medical device, as well as the <strong>total number of devices with lumen<\/strong> should be checked. <strong><sup>[14-16]<\/sup><\/strong> But not only, as in all terminal sterilization modalities, also the <strong>total load weight<\/strong> should be controlled. <strong><sup>[14-16]<\/sup><\/strong> The different combinations of these loading requirements play a crucial role to achieve sterilization, as if any of them is not fulfilled there is no sterilization warranty in the complete load. This is an extra stress factor to the operator.<\/p>\n<h3><strong>THE EASE OF LOAD &#8211; Low Temperature Steam &amp; Formaldehyde<\/strong><\/h3>\n<p>On the other hand, <strong>Low Temperature Steam and Formaldehyde <\/strong>technology offers excellent penetrability performance, thanks to the use of steam to transport the sterilant into the narrow lumens and the high stability of the formaldehyde molecule. This allows the technology to require simple loading specifications; only the <strong>total load weight<\/strong> should be confirmed.<\/p>\n<p>The following table shows penetrability tests results from Matachana Test Center using biological indicatorsinside a process challenge device (PCD) receptacle with different lumen lengths and inner diameters. Asfor the LTSF process, the biological indicators used comply with the requirements of ISO 11138-5Standard. For the hydrogen peroxide tests, biological indicators based on Geobacillus stearothermophilusspores were used, whose resistance was characterized in liquid suspension, an approach that allows themicrobiological resistance parameters of the biological indicator to be determined in a reproducible manner,as described in the scientific literature<strong><sup>[18]<\/sup><\/strong><\/p>\n<p>In this case, the general requirements established in UNE-EN ISO 11138-1 apply.<\/p>\n<p>Table 1<strong>.<\/strong> <strong>Sterilization efficacy comparison between VH2O2 and LTSF technologies in stainless steel lumens.<\/strong><\/p>\n<table style=\"border-color: #FFFFFF;\" align=\"center\">\n<tbody>\n<tr style=\"border-color: #FFFFFF; background-color: #1b365d;\">\n<td style=\"border-color: #FFFFFF; background-color: #1b365d;\" align=\"center\" width=\"100px\"><span style=\"color: rgba(255,255,255,1.00);\">Inner \uf0c6\u00a0<br \/>[mm]&lt;<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #1b365d;\" align=\"center\" width=\"100px\"><span style=\"color: rgba(255,255,255,1.00);\">Length<br \/>[mm]<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #1b365d;\" align=\"center\" width=\"250px\"><span style=\"color: rgba(255,255,255,1.00);\">LTSF Sterilization<br \/>Pass\/Fail<\/td>\n<td style=\"border-color: #FFFFFF; background-color: #1b365d;\" align=\"center\" width=\"250px\"><span style=\"color: rgba(255,255,255,1.00);\">VH2O2 Sterilization<br \/>Pass\/Fail<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #FFFFFF;\">\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" rowspan=\"2\" align=\"center\"><span style=\"color: gray;\">0,5<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" align=\"center\"><span style=\"color: gray;\">500<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #f48082;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Fail<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #FFFFFF;\">\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" align=\"center\"><span style=\"color: gray;\">1000<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #f48082;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Fail<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #f48082;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Fail<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #FFFFFF;\">\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" rowspan=\"3\" align=\"center\"><span style=\"color: gray;\">0,7<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" align=\"center\"><span style=\"color: gray;\">500<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #FFFFFF;\">\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" align=\"center\"><span style=\"color: gray;\">1000<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #FFFFFF;\">\n<td style=\"border-color: #FFFFFF; background-color: #eeeeee;\" align=\"center\"><span style=\"color: gray;\">2000<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #86e378;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Pass<\/span><\/td>\n<td style=\"border-color: #FFFFFF; background-color: #f48082;\" align=\"center\"><span style=\"color: rgba(255,255,255,1.00);\">Fail<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Table 1<\/strong> confirms the highest penetrability performance compared to VH2O2 sterilizers, which typically are not compatible with rigid lumens below 0.7 mm inner diameter and longer than 500 mm. <strong><sup>[14]<\/sup><\/strong> In any case, some manufacturers<strong><sup>[16]<\/sup><\/strong> claim 0.48 mm inner diameter with length no longer than 100 mm, but always limiting the number of lumens up to 20.<\/p>\n<h2>\u00a0<\/h2>\n<h3><strong>CONCLUSIONS<\/strong><\/h3>\n<p>In conclusion, LTSF sterilization process is gentler with materials compared to other low temperature technologies, as its microbicidal effect, rooted in denaturalizing proteins rather than oxidation, minimizes damage to materials.<\/p>\n<ul>\n<li><strong>Sterilization Efficacy<\/strong>: Both LTSF and VH2O2 provide high sterilization efficacy, yet their mechanisms differ significantly.<\/li>\n<\/ul>\n<ul>\n<li><strong>Material Compatibility<\/strong>: LTSF distinguishes itself for its gentle treatment of materials, particularly sensitive instruments, due to its <strong>protein denaturation<\/strong> mechanism, contrasting with VH2O2\u2019s potential long-term oxidative impact on materials.<\/li>\n<\/ul>\n<ul>\n<li><strong>Operational Ease<\/strong>: LTSF technology offers operational simplicity, requiring only adherence to <strong>total weight<\/strong> requirements during the loading process.<\/li>\n<\/ul>\n<p>Choosing between these technologies depends on factors such as device materials, facility protocols, and regulatory compliance. Understanding these nuances ensures optimal sterilization outcomes while maintaining the integrity of medical instruments.<\/p>\n<hr size=\"2px\" \/>\n<h3>BIBLIOGRAPHY<\/h3>\n<p><strong><sup>1<\/sup><\/strong> <em>Reusable medical device \u2013 Wfhss Guidelines<\/em>. (n.d.). Retrieved June 20, 2024, from <a href=\"https:\/\/wfhss-guidelines.com\/reusable-medical-device\/\">https:\/\/wfhss-guidelines.com\/reusable-medical-device\/<\/a><\/p>\n<p><strong><sup>2<\/sup><\/strong> Rivlin, M., Eliav, U., &amp; Navon, G. (2015). NMR studies of the equilibria and reaction rates in aqueous solutions of formaldehyde. <em>Journal of Physical Chemistry B<\/em>, <em>119<\/em>(12), 4479\u20134487. <a href=\"https:\/\/doi.org\/10.1021\/JP513020Y\">https:\/\/doi.org\/10.1021\/JP513020Y<\/a><\/p>\n<p><strong><sup>3<\/sup><\/strong> Gold, A., Utterback, D. F., &amp; Millington, D. S. (1984). Quantitative Analysis of Gas-Phase Formaldehyde Molecular Species at Equilibrium with Formalin Solution. <em>Analytical Chemistry<\/em>, <em>56<\/em>(14), 2879\u20132882. <a href=\"https:\/\/doi.org\/10.1021\/AC00278A058\">https:\/\/doi.org\/10.1021\/AC00278A058<\/a><\/p>\n<p><strong><sup>4 <\/sup><\/strong>Winkelman, J. G. M., Ottens, M., &amp; Beenackers, A. A. C. M. (2000). The kinetics of the dehydration of methylene glycol. In <em>Chemical Engineering Science<\/em> (Vol. 55, Issue 11). PERGAMON-ELSEVIER SCIENCE LTD. <a href=\"https:\/\/research.rug.nl\/en\/publications\/the-kinetics-of-the-dehydration-of-methylene-glycol\">https:\/\/research.rug.nl\/en\/publications\/the-kinetics-of-the-dehydration-of-methylene-glycol<\/a><\/p>\n<p><strong><sup>5<\/sup><\/strong> Winkelman, J. G. M., Voorwinde, O. K., Ottens, M., Beenackers, A. A. C. M., &amp; Janssen, L. P. B. M. (2002). Kinetics and chemical equilibrium of the hydration of formaldehyde. <em>Chemical Engineering Science<\/em>, <em>57<\/em>(19), 4067\u20134076. <a href=\"https:\/\/doi.org\/10.1016\/S0009-2509(02)00358-5\">https:\/\/doi.org\/10.1016\/S0009-2509(02)00358-5<\/a><\/p>\n<p><strong><sup>6<\/sup><\/strong> Matubayasi, N., Morooka, S., Nakahara, M., &amp; Takahashi, H. (2007). Chemical equilibrium of formaldehyde and methanediol in hot water: Free-energy analysis of the solvent effect. <em>Journal of Molecular Liquids<\/em>, <em>134<\/em>(1\u20133), 58\u201363. <a href=\"https:\/\/doi.org\/10.1016\/J.MOLLIQ.2006.12.002\">https:\/\/doi.org\/10.1016\/J.MOLLIQ.2006.12.002<\/a><\/p>\n<p><strong><sup>7<\/sup><\/strong> Kent, D. R., Widicus, S. L., Blake, G. A., Goddard, W. A., &amp; Iii, W. A. G. (2003). A theoretical study of the conversion of gas phase methanediol to formaldehyde \ue904 A theoretical study of the conversion of gas phase methanediol to formaldehyde. <em>J. Chem. Phys<\/em>, <em>119<\/em>, 5117\u20135120. https:\/\/doi.org\/10.1063\/1.1596392<\/p>\n<p><sup>\u00a0<\/sup><strong><sup>8 <\/sup><\/strong>Kleimeier, C. F., Turner, N. F., Singh, A. M., Fortenberry, S. K., &amp; Kaiser, R. C. (2022). Synthesis of methanediol [CH 2 (Oh) 2 ]: The simplest geminal diol. <em>Proceedings of the National Academy of Sciences<\/em>, <em>119<\/em>(1), 2111938119. <a href=\"https:\/\/doi.org\/10.1073\/pnas.2111938119\">https:\/\/doi.org\/10.1073\/pnas.2111938119<\/a><\/p>\n<p><strong><sup>9 <\/sup><\/strong>Lilienblum, W. (2012). <em>Opinion of the Scientific Committee on Consumer Safety on methylene glycol; Opinion of the Scientific Committee on Consumer Safety on methylene glycol<\/em>. https:\/\/doi.org\/10.2772\/83316<\/p>\n<p><strong><sup>10 <\/sup><\/strong>World Health Organization. (2016). <em>Decontamination and Reprocessing of Medical Devices for Health-care Facilities<\/em>. <a href=\"https:\/\/iris.who.int\/bitstream\/handle\/10665\/250232\/9789241549851-eng.pdf;jsessionid=3D2B2C5446E0235F3AEEE6006D7EBA16?sequence=1\">http:\/\/www.who.int<\/a><\/p>\n<p><strong><sup>11<\/sup><\/strong> Mcdonnell, G., Russell, A. D., Operations, L., &amp; Louis, S. (1999). Antiseptics and Disinfectants: Activity, Action, and Resistance. <em>CLINICAL MICROBIOLOGY REVIEWS<\/em>, <em>12<\/em>(1), 147\u2013179.<\/p>\n<p><strong><sup>12<\/sup><\/strong> Loshon, C. A., Genest, P. C., Setlow, B., &amp; Setlow, P. (1999). Formaldehyde kills spores of Bacillus subtilis by DNA damage and small, acid-soluble spore proteins of the alpha\/beta-type protect spores against this DNA damage. <em>Journal of Applied Microbiology<\/em>, <em>87<\/em>(1), 8\u201314. <a href=\"https:\/\/doi.org\/10.1046\/J.1365-2672.1999.00783.X\">https:\/\/doi.org\/10.1046\/J.1365-2672.1999.00783.X<\/a><\/p>\n<p><strong><sup>13<\/sup><\/strong> Tao, M., Ao, T., Mao, X., Yan, X., Javed, R., Hou, W., Wang, Y., Sun, C., Lin, S., Yu, T., &amp; Ao, Q. (2021). Sterilization and disinfection methods for decellularized matrix materials: Review, consideration and proposal. <em>Bioactive Materials<\/em>, <em>6<\/em>(9), 2927. <a href=\"https:\/\/doi.org\/10.1016\/J.BIOACTMAT.2021.02.010\">https:\/\/doi.org\/10.1016\/J.BIOACTMAT.2021.02.010<\/a><\/p>\n<p><strong><sup>14<\/sup><\/strong> STERRAD User\u2019s Guide REF A11150401. ASP. Retrieved June 20, 2024, from <a href=\"https:\/\/eifu.asp.com\/\">https:\/\/eifu.asp.com\/<\/a><\/p>\n<p><strong><sup>15<\/sup><\/strong> STERRADTM Low temperature sterilization.\u00a0 ASP. Retrieved June 20, 2024, from <a href=\"https:\/\/www.asp.com\/low-temp-esterilization\">https:\/\/www.asp.com\/low-temp-esterilization<\/a><\/p>\n<p><strong><sup>16<\/sup><\/strong> STERIS <em>Instructions For Use | Operator Manual. <\/em>STERIS. EN 10085896 Revision H. Retrieved June 20, 2024, from <a href=\"https:\/\/www.steris.com\/healthcare\/instructions-for-use\">https:\/\/www.steris.com\/healthcare\/instructions-for-use<\/a><\/p>\n<p><strong><sup>17<\/sup><\/strong> Adapted from \u201cKouchmeshky, A., &amp; McCaffery, P. (2020). Use of fixatives for immunohistochemistry and their application for detection of retinoic acid synthesizing enzymes in the central nervous system. <em>Methods in Enzymology<\/em>, 637, 119\u2013150. <a href=\"https:\/\/doi.org\/10.1016\/BS.MIE.2020.03.010\">https:\/\/doi.org\/10.1016\/BS.MIE.2020.03.010<\/a>\u201d with <a href=\"http:\/\/www.biorender.com\/\">BioRender.com <\/a>\u00a0<\/p>\n<p><strong><sup>18<\/sup><\/strong> Deinhard, B., Hartmann, B., &#038; Heeg, P. (2015). Resistance of <em>Geobacillus stearothermophilus<\/em> spores used in biological indicators for hydrogen peroxide sterilization processes. <em>Journal of Hospital Infection<\/em>, 91(3), 234\u2013240.<\/p>\n<p>\n  <a href=\"https:\/\/matachanagroup.box.com\/s\/smuqozsje99lueii9hs8rsemzc5xoh99\" target=\"_blank\" rel=\"noopener noreferrer\"><br \/>\n    <img decoding=\"async\" src=\"https:\/\/www.matachana.com\/wp-content\/uploads\/2024\/07\/ICO_Descarga_PDF_en.png\" width=\"250\" \/><br \/>\n  <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Comparison in terms of gentleness &amp; ease of use with medical devices &nbsp; Authors: Dr. Daniel V\u00e1zquez1; Dr. Nelson Carreras2; Dr. Alex Zamora3; Ing. Alejandro Ram\u00edrez4. 1Matachana Test Center Coordinator, 2Global Product Manager Consumables, 3RDI Chemist, 4Global Product Manager Low Temperature Sterilizers. Abbreviations: VH202 \u2013 Vaporized Hydrogen Peroxide, LTSF \u2013 Low Temperature Steam and Formaldehyde, [&hellip;]<\/p>\n","protected":false},"author":13,"featured_media":272012,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false},"categories":[182],"tags":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>MATACHANA - REPROCESSING LAPAROSCOPY<\/title>\n<meta name=\"description\" content=\"REPROCESSING LAPAROSCOPY USING LOW TEMPERATURE STERILIZATION\u2026VH2O2 or LTSF?\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.matachana.com\/en\/reprocessing-laparoscopy-using-low-temperature-sterilizationvh2o2-or-ltsf\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"MATACHANA - 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