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Olavarria OA, Chhabra KR, Levi ST, Wilson EB, Hutter MM. Small bowel magnetic compression anastomosis creation for bypass procedures in a porcine model. Surg Endosc 2025; 39:2155-2163. [PMID: 39904790 DOI: 10.1007/s00464-025-11575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/20/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Stapled and hand-sewn techniques dominate gastrointestinal anastomotic procedures. These techniques are effective but not without flaws. Retained foreign bodies, pathways from mucosa to serosa, and increased scar tissue are some of the drawbacks, and can lead to postoperative complications. The GI Windows Flexagon™ system utilizes self-forming magnets (SFM's) to create anastomoses by compression, sealing serosa to serosa, leaving no foreign bodies. Combining the Flexagon™ SFM with the OTOLoc™ device (implant with a central lumen which provides radial support to the enterotomies), enables immediate flow through the anastomosis and facilitates creation of enteral bypass procedures unique to this technology. We sought to compare the safety and efficacy of the GI Windows Flexagon™ and OTOLoc™ technologies against conventional stapling. METHODS A preclinical study was conducted on 14 Yorkshire swine to compare laparoscopic magnetic and stapled duodenoileostomies and jejunojejunostomies. Study endpoints included: adverse or serious adverse events, anastomotic burst pressure, adhesions, histopathology, and bacterial ingress. A Likert scale was used to assess the usability of the devices. RESULTS All procedures were successfully completed via laparoscopic approach; no adverse or serious adverse events were observed at the 42-day endpoint. All SFM's were expelled in less than 20 days. Average anastomotic burst pressure was 129.2 mmHg for SFM compared to 79.4 mmHg in stapled controls. Adhesion scores were similar between groups. Histopathology revealed that magnetic anastomoses have less intestinal wall distortion, fewer signs of chronic inflammation, and no bacterial ingress. The usability of all devices was reported as "Easy" or "Very Easy." CONCLUSION GI Windows magnetic compression anastomoses creation in this porcine model revealed an overall ease of use, all while demonstrating procedural feasibility, safety, and clinical effectiveness. Surprisingly, in nearly all results assessed, SFM anastomoses were found to be comparable to the control stapled anastomoses in regard to structural, physiological, and histological endpoints.
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Affiliation(s)
- Oscar A Olavarria
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center Houston, 6431 Fannin St, MSB 4.162B, Houston, TX, 77030, USA.
| | - Karan R Chhabra
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Shoshana T Levi
- Department of Surgical Oncology, MD Anderson Cancer Center, The University of Texas Health Science Center Houston, Houston, USA
| | - Erik B Wilson
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center Houston, 6431 Fannin St, MSB 4.162B, Houston, TX, 77030, USA
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Liu SQ, Zhang HK, Lv Y, Xu XH, Li YF, Quan DW. Magnamosis for rectal reconstruction in canines. World J Gastrointest Surg 2025; 17:97862. [DOI: 10.4240/wjgs.v17.i2.97862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 10/25/2024] [Accepted: 12/03/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND The magnamosis, a minimal invasive, suture-free procedure, has been used for digestive tract or vessel reconstruction, such as gastrointestinal anastomosis, bilioenteric anastomosis, and coronary artery bypass. Although some case reports have demonstrated the potential of magnamosis for the treatment of congenital rectal atresia (RA), they cannot provide strong evidence for its widespread application.
AIM To assess the feasibility and safety of magnamosis in treating RA in dogs as compared to suturing anastomosis. The findings of this study can be beneficial in guiding the clinical application of magnamosis.
METHODS Thirty-six dogs were randomly assigned to the magnamosis group (n =18) and the suturing anastomosis group (n =18). The rectum was freed laparoscopically in all dogs. In the magnamosis group, rectal anastomosis was performed using a pair of magnetic rings, while the suturing anastomosis group underwent a straight-sighted end-to-end rectal anastomosis with 4-0 absorbable sutures. The anastomosis time was recorded, and abdominal plain film examination was performed to locate the magnets until they were expelled postoperatively. Specimens of the anastomosis were evaluated at one month, three months, and six months after surgery.
RESULTS The mean time for rectal anastomosis was significantly shorter in the magnamosis group (12.22 ± 2.78 minutes) than the suturing anastomosis group (18.11 ± 1.68 minutes). There was one incidence of anastomotic bleeding in the suturing anastomosis group, whereas no complication was recorded in the magnamosis group. The magnets were discharged post-surgery in 7.17 ± 1.30 days in all the dogs. The histopathological examination revealed a smoother healing of anastomotic mucosa in the magnamosis group as compared to that in the suturing anastomosis group. Moreover, the fiber alignment was also more natural in the magnamosis group with minimal inflammation.
CONCLUSION Rectal reconstruction using magnamosis is a feasible, safe, and effective alternative to suturing anastomosis in dogs, with the added benefit of faster and more natural healing of the anastomosis.
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Affiliation(s)
- Shi-Qi Liu
- Medical College, Xijing University, Xi’an 710123, Shaanxi Province, China
| | - Hong-Ke Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xiang-Hua Xu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yu-Feng Li
- Department of Pediatric Surgery, Guilin Maternal and Child Health Hospital, Guilin 541001, Guangxi Zhuang Autonomous Region, China
| | - Dong-Wen Quan
- The Second Clinical Medical School, Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China
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Shakir T, Pampiglione T, Hassouna M, Rogers P, Dourado J, Emile S, Kokelaar R, Wexner S. New alternative colorectal anastomotic devices: A systematic review and meta-analysis. Am J Surg 2025; 240:116128. [PMID: 39671968 DOI: 10.1016/j.amjsurg.2024.116128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/26/2024] [Accepted: 11/29/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND Colorectal anastomotic devices have been used for nearly a century, with stapled anastomoses being the most common despite leak rates up to 20 %. This review aimed to evaluate newer alternative devices. METHOD A systematic review and meta-analysis of publications from the last decade were conducted, focusing on devices forming colorectal anastomoses, excluding those facilitating sutured or stapled anastomoses or designed to prevent leaks. Data from MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were analysed. RESULTS Eighteen studies (7 human, 10 animal, 1 ex-vivo) involving 955 anastomoses were included. Compression mechanisms were the most common. The pooled complication rate in human studies was 9.7 % (95 % CI: 4.3-15.2 %) with significant heterogeneity (I2 = 81.7 %). The leak rate after compression anastomoses was 3.3 % (95 % CI: 1.9-4.7 %) with no heterogeneity (I2 = 0 %). A novel device with transanal catheters allowed intraoperative and postoperative assessment. CONCLUSIONS Outcomes are comparable to existing methods, with new technologies offering promising advancements.
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Affiliation(s)
- T Shakir
- University College London Hospital, UK.
| | | | | | - P Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - J Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - S Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | | | - S Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Hall A, Emil S, Elhafid M, Guadagno E, Kattini C, Keijzer R, Klapman S, Laberge JM, Livingston M, Puligandla P, Nasr A, Snarr P, Youssef F, Zani A. The Canadian Experience With Magnetic Esophageal Anastomosis: A Report From the Canadian Consortium for Research in Pediatric Surgery Study (CanCORPS). J Pediatr Surg 2025:162150. [PMID: 39824744 DOI: 10.1016/j.jpedsurg.2024.162150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/04/2024] [Accepted: 12/30/2024] [Indexed: 01/20/2025]
Abstract
OBJECTIVE Magnetic anastomosis is an innovative technique for establishing esophageal continuity in infants born with esophageal atresia. Few case series featuring this technology have been published, with even fewer reports on complications. We present the entire Canadian experience with this approach. METHODS A nationwide retrospective review of all esophageal atresia patients treated with magnetic anastomoses in Canada was conducted through the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). RESULTS Magnetic anastomoses were attempted in nine patients including four Type A, two Type B, and three Type C. The median pre-operative esophageal gap was 2.9 cm (range 0.0-5.5 cm). In four patients, magnetic anastomosis was used as a salvage technique, after failed attempted primary repair. Seven patients (78 %) achieved esophageal patency after magnet insertion. Strictures developed in all successful cases and required a median of 10 dilatations (range 3-16). In one patient with a failed anastomosis, the proximal magnet perforated the proximal esophageal pouch, while in the second case, the magnets failed to couple together. One patient had an anastomosis form but required operative intervention shortly afterwards to both revise the anastomosis and address a missed proximal fistula. CONCLUSION In the Canadian experience, magnetic anastomosis was successful in establishing esophageal continuity in most patients. However, all patients developed strictures requiring multiple dilatations, and there was a substantial risk of complications requiring additional operative procedures. Further refinement of this technique may establish magnetic anastomosis as another tool for the pediatric surgeon treating long-gap and other challenging cases of esophageal atresia.
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Affiliation(s)
- Amanda Hall
- Jim Pattison Children's Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada.
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Db Decarie, Montreal, Quebec H4A 3J1, Canada.
| | - Melanie Elhafid
- Jim Pattison Children's Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada.
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Db Decarie, Montreal, Quebec H4A 3J1, Canada.
| | - Cesar Kattini
- The Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario K1H 8L1, Canada.
| | - Richard Keijzer
- The Children's Hospital of Winnipeg, 840 Sherbrook St, Winnipeg, Manitoba R3E 0Z3, Canada.
| | - Sarah Klapman
- McMaster Children's Hospital, 1200 Main St, West Hamilton, Ontario L8N 3Z5, Canada.
| | - Jean-Martin Laberge
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Db Decarie, Montreal, Quebec H4A 3J1, Canada.
| | - Michael Livingston
- McMaster Children's Hospital, 1200 Main St, West Hamilton, Ontario L8N 3Z5, Canada.
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Db Decarie, Montreal, Quebec H4A 3J1, Canada.
| | - Ahmed Nasr
- The Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario K1H 8L1, Canada.
| | - Phillip Snarr
- The Children's Hospital of Winnipeg, 840 Sherbrook St, Winnipeg, Manitoba R3E 0Z3, Canada.
| | - Fouad Youssef
- The Children's Hospital of Winnipeg, 840 Sherbrook St, Winnipeg, Manitoba R3E 0Z3, Canada.
| | - Augusto Zani
- The Hospital for Sick Children, Toronto, Ontario, Canada.
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5
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Gagner M, Krinke T, Lapointe-Gagner M, Buchwald JN. Magnetic compression anastomosis gastrojejunostomy: feasibility and efficacy of a novel device in a swine model. Surg Obes Relat Dis 2024; 20:1098-1107. [PMID: 38879418 DOI: 10.1016/j.soard.2024.04.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Means of addressing technical challenges in forming gastrojejunostomy (GJ) anastomoses and maintaining their patency are sought. OBJECTIVES Evaluation of preclinical feasibility and healing efficacy of a novel linear magnetic compression anastomosis (MCA) device to form a patent GJ versus sutured jejunal enterotomy (JE) sites in swine. SETTING Single-center veterinary testing facility. METHODS Feasibility of 3 prototype sizes (4, 6, and 8 cm) of a metal MCA device (MCAD) to form a patent GJ was evaluated over 6 weeks. A distal magnet was laparoscopically inserted in the jejunum, a proximal magnet was placed gastroscopically in the stomach; magnets were aligned to gradually form an anastomosis, self-detached, and be expelled. At necropsy, MCAs were assessed for patency and compared with JE tissues to evaluate wound healing. RESULTS MCADs aligned at the GJ location without complications. In 5/6 MCAD pairs, dislodgement occurred between 7 and 26 days; expulsion 13-31 days; 1 MCAD pair was retained in the stomach. At necropsy, all pigs were healthy, gaining a mean 15.0 kg. Anastomoses were not adequately patent in 2/4 pigs receiving the 4-cm or 6-cm MCADs because their linear length was too small. But, anastomoses of both pigs receiving the 8-cm MCADs maintained full patency. Minimal inflammation and fibrosis were seen in MCA specimens versus sutured enterotomies. CONCLUSIONS A novel linear MCA device was feasible and effectively created a patent GJ anastomosis in swine with minimal inflammation and fibrosis. The MCAD may be appropriate for clinical evaluation.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada.
| | - Todd Krinke
- GT Metabolic Solutions, San Jose, California
| | | | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, Wisconsin
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Wang T, Li Y, Yu C, Lv X, Weng Y, Zhang Z, Xu H, Liang R, Wang M, Weng Z, Zhang C, Lv Y, Zhang Y. Magnamosis improves the healing of gastrojejunal anastomosis and down-regulates TGF-β1 and HIF-1α in rats. Sci Rep 2024; 14:20367. [PMID: 39223174 PMCID: PMC11369180 DOI: 10.1038/s41598-024-71215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
This study elucidated the unique pathological features of tissue healing by magnamosis and revealed the changes in landmark molecule expression levels related to collagen synthesis and tissue hypoxia. Forty-eight male Sprague-Dawley rats were divided into the magnamosis and suture anastomosis groups, and gastrojejunal anastomosis surgery was performed. Rats were dissected at 6, 24, and 48 h and 5, 6, 8, 10, and 12 days postoperatively. Hematoxylin, eosin, and Masson's trichrome staining were used to evaluate granulation tissue proliferation and collagen synthesis density at the anastomosis site. Immunohistochemistry was used to measure TGF-β1 and HIF-1α expression levels. Magnamosis significantly shortened the operation time, resulting in weaker postoperative abdominal adhesions (P < 0.0001). Histopathological results showed a significantly lower granulation area in the magnamosis group than in the suture anastomosis group (P = 0.0388), with no significant difference in the density of collagen synthesis (P = 0.3631). Immunohistochemistry results indicated that the magnamosis group had significantly lower proportions of TGF-β1-positive cells at 24 (P = 0.0052) and 48 h (P = 0.0385) postoperatively and HIF-1α-positive cells at 24 (P = 0.0402) and 48 h postoperatively (P = 0.0005). In a rat model of gastrojejunal anastomosis, magnamosis leads to improved tissue healing at the gastrojejunal anastomosis, associated with downregulated expression levels of TGF-β1 and HIF-1α.
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Affiliation(s)
- Tianren Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710067, China
| | - Yunhao Li
- Department of Geriatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710067, China
| | - Chenao Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710067, China
| | - Xinru Lv
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Yuxuan Weng
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Zhixuan Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Haozhen Xu
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Runjia Liang
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Mengyue Wang
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Zhenzhen Weng
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Cheng Zhang
- Xi'an Jiaotong University Medical Science Center, Xi'an, 710067, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710067, China.
| | - Yong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710067, China.
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Zhang MM, Sha HC, Xue HR, Qin YF, Song XG, Li Y, Li Y, Deng ZW, Gao YL, Dong FF, Lyu Y, Yan XP. Novel magnetic compression technique for the treatment of postoperative anastomotic stenosis in rectal cancer: A case report. World J Gastrointest Surg 2024; 16:1926-1932. [PMID: 38983326 PMCID: PMC11230028 DOI: 10.4240/wjgs.v16.i6.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The treatment of postoperative anastomotic stenosis after excision of rectal cancer is challenging. Endoscopic balloon dilation and radial incision are not effective in all patients. We present a new endoscopy-assisted magnetic compression technique (MCT) for the treatment of rectal anastomotic stenosis. We successfully applied this MCT to a patient who developed an anastomotic stricture after radical resection of rectal cancer. CASE SUMMARY A 50-year-old man had undergone laparoscopic radical rectal cancer surgery at a local hospital 5 months ago. A colonoscopy performed 2 months ago indicated that the rectal anastomosis was narrow due to which ileostomy closure could not be performed. The patient came to the Magnetic Surgery Clinic of the First Affiliated Hospital of Xi'an Jiaotong University after learning that we had successfully treated patients with colorectal stenosis using MCT. We performed endoscopy-assisted magnetic compression surgery for rectal stenosis. The magnets were removed 16 d later. A follow-up colonoscopy performed after 4 months showed good anastomotic patency, following which, ileostomy closure surgery was performed. CONCLUSION MCT is a simple, non-invasive technique for the treatment of anastomotic stricture after radical resection of rectal cancer. The technique can be widely used in clinical settings.
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Affiliation(s)
- Miao-Miao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- Department of National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Huan-Chen Sha
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Hai-Rong Xue
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yuan-Fa Qin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xiao-Gang Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yun Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Zheng-Wu Deng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yu-Lin Gao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Fang-Fang Dong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- Department of National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- Department of National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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8
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Lee AY, Cho JY. Clinical diagnostic advances in intestinal anastomotic techniques: Hand suturing, stapling, and compression devices. World J Gastrointest Surg 2024; 16:1231-1234. [PMID: 38817301 PMCID: PMC11135308 DOI: 10.4240/wjgs.v16.i5.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 04/28/2024] [Indexed: 05/23/2024] Open
Abstract
The development of intestinal anastomosis techniques, including hand suturing, stapling, and compression anastomoses, has been a significant advancement in surgical practice. These methods aim to prevent leakage and minimize tissue fibrosis, which can lead to stricture formation. The healing process involves various phases: hemostasis and inflammation, proliferation, and remodeling. Mechanical staplers and sutures can cause inflammation and fibrosis due to the release of profibrotic chemokines. Compression anastomosis devices, including those made of nickel-titanium alloy, offer a minimally invasive option for various surgical challenges and have shown safety and efficacy. However, despite advancements, anastomotic techniques are evaluated based on leakage risk, with complications being a primary concern. Newer devices like Magnamosis use magnetic rings for compression anastomosis, demonstrating greater strength and patency compared to stapling. Magnetic technology is also being explored for other medical treatments. While there are promising results, particularly in animal models, the real-world application in humans is limited, and further research is needed to assess their safety and practicality.
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Affiliation(s)
- Ah Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, Cha University College of Medicine, Seoul 06135, South Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, Cha University College of Medicine, Seoul 06135, South Korea
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Zhang M, Zhong Q, Ma J, Mao J, Shi A, Lyu Y, Yan X. Feasibility experiment of a novel deformable self-assembled magnetic anastomosis ring (DSAMAR) for gastrointestinal anastomosis through a natural orifice. Sci Rep 2024; 14:10602. [PMID: 38719935 PMCID: PMC11078934 DOI: 10.1038/s41598-024-60887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Although the application of magnetic compression anastomosis is becoming increasingly widespread, the magnets used in earlier studies were mostly in the shape of a whole ring. Hence, a deformable self-assembled magnetic anastomosis ring (DSAMAR) was designed in this study for gastrointestinal anastomosis. Furthermore, its feasibility was studied using a beagle model. The designed DSAMAR comprised 10 trapezoidal magnetic units. Twelve beagles were used as animal models, and DSAMARs were inserted into the stomach and colon through the mouth and anus, respectively, via endoscopy to achieve gastrocolic magnamosis. Surgical time, number of failed deformations, survival rate of the animals, and the time of magnet discharge were documented. A month later, specimens of the anastomosis were obtained and observed with the naked eye as well as microscopically. In the gastrocolic anastomosis of the 12 beagles, the procedure took 65-120 min. Although a deformation failure occurred during the operation in one of the beagles, it was successful after repositioning. The anastomosis was formed after the magnet fell off 12-18 days after the operation. Naked eye and microscopic observations revealed that the anastomotic specimens obtained 1 month later were well-formed, smooth, and flat. DSAMAR is thus feasible for gastrointestinal anastomosis under full endoscopy via the natural orifice.
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Affiliation(s)
- Miaomiao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiuye Zhong
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Jia Ma
- Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jianqi Mao
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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10
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Tian BY, Zhang MM, Ma J, Lyu Y, Yan XP. Influence of different magnetic forces on the effect of colonic anastomosis in rats. World J Gastrointest Surg 2024; 16:860-870. [PMID: 38577092 PMCID: PMC10989341 DOI: 10.4240/wjgs.v16.i3.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite much work having been conducted on magnetic compression anastomosis (MCA) in the digestive tract, there are no reports on the influence of magnetic force on the anastomosis. AIM To investigate the effect of different magnetic force magnets on the MCA of the digestive tract. METHODS Two groups of magnets of the same sizes but different magnetic forces were designed and produced. A total of 24 Sprague-Dawley rats were randomly assigned into two groups (powerful magnet group and common magnet group), with 12 rats in each group. Two types of magnets were used to complete the colonic side-to-side anastomosis of the rats. The operation time and magnet discharge time were recorded. The anastomotic specimens were obtained 4 wk after the operation and then the burst pressure and diameter of the anastomosis were measured, and the anastomosis was observed via the naked eye and subjected to histological examination. RESULTS The magnetic forces of the powerful and common magnet groups at zero distance were 8.26 N and 4.10 N, respectively. The colonic side-to-side anastomosis was completed in all 24 rats, and the operation success rate and postoperative survival rate were 100%. No significant difference was noted in the operation time between the two groups. The magnet discharge time of the powerful magnet group was slightly longer than that of the common magnet group, but the difference was not statistically significant (P = 0.513). Furthermore, there was no statistical difference in the burst pressure (P = 0.266) or diameter of magnetic anastomosis (P = 0.095) between the two groups. The gross specimens of the two groups showed good anastomotic healing, and histological observation indicated good mucosal continuity without differences on healing. CONCLUSION In the rat colonic side-to-side MCA model, both the powerful magnet with 8.26 N and the common magnet with 4.10 N showed no significant impact on the anastomosis establishment process or its effect.
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Affiliation(s)
- Bo-Yan Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Miao-Miao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Jia Ma
- Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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11
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Lee WG, Evans LL, Chen CS, Fuchs JR, Zamora IJ, Bruzoni M, Harrison MR, Muensterer OJ. Lessons Learned From the First-In-Human Compassionate Use of Connect-EA™ in Ten Patients With Esophageal Atresia. J Pediatr Surg 2024; 59:437-444. [PMID: 37838619 DOI: 10.1016/j.jpedsurg.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Delayed primary repair of esophageal atresia in patients with high-risk physiologic and anatomic comorbidities remains a daunting challenge with an increased risk for peri-operative morbidity and mortality via conventional repair. The Connect-EA device facilitates the endoscopic creation of a secure esophageal anastomosis. This follow-up study reports our long-term outcomes with the novel esophageal magnetic compression anastomosis (EMCA) Connect-EA device for EA repair, as well as lessons learned from the ten first-in-human cases. We propose an algorithm to maximize the advantages of the device for EA repair. METHODS Under compassionate use approval, from June 2019 to December 2022, ten patients with prohibitive surgical or medical risk factors underwent attempted EMCA with this device. All patients underwent prior gastrostomy, tracheoesophageal fistula ligation (if necessary), and demonstrated pouch apposition prior to EMCA. RESULTS Successful device deployment and EMCA formation were achieved in nine patients (90%). Mean time to anastomosis formation was 8 days (range 5-14) and the device was retrieved endoscopically in five (56%) cases. At median follow-up of 22 months (range 4-45), seven patients (78%) are tolerating oral nutrition. Balloon dilations (median 4, range 1-11) were performed either prophylactically for radiographic asymptomatic anastomotic narrowing (n = 7, 78%) or to treat clinically-significant anastomotic narrowing (n = 2, 22%) with no ongoing dilations at 3-month follow up post-repair. CONCLUSION EMCA with the Connect-EA device is a safe and feasible minimally-invasive alterative for EA repair in high-risk surgical patients. Promising post-operative outcomes warrant further Phase I investigation. LEVEL OF EVIDENCE IV, Case series of novel operative technique without comparison group.
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Affiliation(s)
- William G Lee
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Lauren L Evans
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Caressa S Chen
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Julie R Fuchs
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville, TN 37232, USA
| | - Matias Bruzoni
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Munich, Lindwurmstrasse 4, 80337, Munich, Germany.
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12
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Zhang MM, Sha HC, Qin YF, Lyu Y, Yan XP. Y-Z deformable magnetic ring for the treatment of rectal stricture: A case report and review of literature. World J Gastroenterol 2024; 30:599-606. [PMID: 38463020 PMCID: PMC10921145 DOI: 10.3748/wjg.v30.i6.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Treatment of postoperative anastomotic stenosis for colorectal cancer is often challenging, especially for patients who do not respond well to endoscopy. In cases where patients have undergone an enterostomy, the stenosis can be easily resolved through magnetic compression. However, common magnetic compression techniques cannot be performed on those without enterostomy. We designed a novel Y-Z deformable magnetic ring (Y-Z DMR) and successfully applied it to a patient with a stenosis rectal anastomosis and without enterostomy after rectal cancer surgery. CASE SUMMARY We here report the case of a 57-year-old woman who had undergone a laparoscopic radical rectum resection (Dixon) for rectal cancer. However, she started facing difficulty in defecation 6 months after surgery. Her colonoscopy indicated stenosis of the rectal anastomosis. Endoscopic balloon dilation was performed six times on her. However, the stenosis still showed a trend of gradual aggravation. Because the patient did not undergo an enterostomy, the conventional endoscopic magnetic compression technique could not be performed. Hence, we implemented a Y-Z DMR implemented through the anus under single channel. The magnetic ring fell off nine days after the operation and the rectal stenosis was relieved. The patient was followed up for six months and reported good defecation. CONCLUSION The Y-Z DMR deformable magnetic ring is an excellent treatment strategy for patients with rectal stenosis and without enterostomy.
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Affiliation(s)
- Miao-Miao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Huan-Chen Sha
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yuan-Fa Qin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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13
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Evans LL, Lee WG, Karimzada M, Patel VH, Aribindi VK, Kwiat D, Graham JL, Cummings DE, Havel PJ, Harrison MR. Evaluation of a Magnetic Compression Anastomosis for Jejunoileal Partial Diversion in Rhesus Macaques. Obes Surg 2024; 34:515-523. [PMID: 38135738 PMCID: PMC10810932 DOI: 10.1007/s11695-023-07012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Metabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model. MATERIALS AND METHODS Using an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight). RESULTS Device mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p < 0.05). Total weight also decreased in a linear fashion (R2 = 0.97) with total weight loss at 6 weeks post-device placement of 14.4% (p < 0.05). CONCLUSION The use of this novel magnetic compression device to create a limited caliber side-to-side jejunoileal anastomosis is safe and likely feasible in a nonhuman primate model. The observed glucoregulatory and metabolic effects of a partial jejunoileal bypass with this device warrant further investigation to validate the long-term glucometabolic impact of this approach.
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Affiliation(s)
- Lauren L Evans
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - William G Lee
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Mohammad Karimzada
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Veeshal H Patel
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Vamsi K Aribindi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Dillon Kwiat
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - James L Graham
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - David E Cummings
- Division of Metabolism, Endocrinology and Nutrition, University of Washington and VA Puget Sound Health Care System, Seattle, USA
| | - Peter J Havel
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - Michael R Harrison
- Department of Surgery, University of California San Francisco, San Francisco, USA.
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14
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Lee WG, Evans LL, Harrison MR. Beyond the gut: spectrum of magnetic surgery devices. Front Surg 2023; 10:1253728. [PMID: 37942002 PMCID: PMC10628496 DOI: 10.3389/fsurg.2023.1253728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive systems. The majority of current clinical applications for magnetic surgery are largely centered around gastrointestinal uses-such as gastrointestinal or bilioenteric anastomosis creation, stricturoplasty, sphincter augmentation, and the guidance of nasoenteric feeding tubes. However, as the field of magnetic surgery continues to advance, the development and clinical implementation of magnetic devices has expanded to treat a variety of non-gastrointestinal disorders including musculoskeletal (pectus excavatum, scoliosis), respiratory (obstructive sleep apnea), cardiovascular (coronary artery stenosis, end-stage renal disease), and genitourinary (stricture, nephrolithiasis) conditions. The purpose of this review is to discuss the current state of innovative magnetic surgical devices under clinical investigation or commercially available for the treatment of non-gastrointestinal disorders.
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Affiliation(s)
- William G. Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Lauren L. Evans
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michael R. Harrison
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
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15
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Kotlovsky AM, Muensterer OJ, Nikolaev VV, Razumovskiy AY. Magnetic Compression Anastomosis-Past Experience and Current Proposals for Further Development in Pediatric Minimally Invasive Surgery. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1328. [PMID: 37628327 PMCID: PMC10453638 DOI: 10.3390/children10081328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Originating in the 1970s, magnetic compression anastomosis (MCA) has lately been revisited with a focus on minimal invasive surgery (MIS). The aim of this report is to reappraise our earlier experience with MCA with the intention of facilitating future MCA advancement. A retrospective review was conducted regarding preclinical experiments and clinical trials at a single institution from 1980 to 1995. The reviewed information was compiled and appraised to generate proposals for future MCA use. The experimental studies, including 250 MCA cases in gastrointestinal and urinary tract animal models, demonstrated the technical versatility of MCA as well as the superior biomechanical characteristics in comparison to hand-sewn anastomoses. Clinical trials encompassed 87 MCA procedures in 86 children, 2 to 10 years of age, involving the following techniques: non-operative esophageal recanalization (n = 15), non-operative ileostomy undiversion (n = 46), Swenson pull-through (n = 10), non-operative urethral recanalization (n = 5), and extravesical ureterocystoneostomy (n = 11). Clinical MCA was found to be successful in over 87% of cases. MCA limitations concerning anastomotic failure and scarring were thought to be mostly due to inadequate magnetic compression. Based on our historic experience, we propose further research on the technical aspects of MCA, along with the biological aspects of anastomotic tissue remodeling. Magnets should be designed and manufactured for a wide spectrum of pediatric surgical indications, particularly in combination with novel MIS techniques.
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Affiliation(s)
- Anatole M. Kotlovsky
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, Lindwurmstrasse, 480337 Munich, Germany;
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, Lindwurmstrasse, 480337 Munich, Germany;
| | - Vasily V. Nikolaev
- Department of Pediatric Surgery, N.I. Pirogov Russian National Research Medical University, Russian Children’s Hospital, Leninsky Prosp 117, 119571 Moscow, Russia; (V.V.N.); (A.Y.R.)
| | - Alexander Y. Razumovskiy
- Department of Pediatric Surgery, N.I. Pirogov Russian National Research Medical University, Russian Children’s Hospital, Leninsky Prosp 117, 119571 Moscow, Russia; (V.V.N.); (A.Y.R.)
- Department of Pediatric Surgery, Pirogov Russian National Research Medical University, Filatov Children’s Clinical Hospital, Ulitsa Sadovo-Kudrinskay 13, 123001 Moscow, Russia
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16
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Gagner M, Abuladze D, Koiava L, Buchwald JN, Van Sante N, Krinke T. First-in-Human Side-to-Side Magnetic Compression Duodeno-ileostomy with the Magnet Anastomosis System. Obes Surg 2023; 33:2282-2292. [PMID: 37393568 PMCID: PMC10345004 DOI: 10.1007/s11695-023-06708-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
PURPOSES Classical gastrointestinal anastomoses are formed with sutures and/or metal staples, resulting in significant bleeding and leak rates. This study evaluated the feasibility and safety of the novel magnet anastomosis system (MS) to create a side-to-side duodeno-ileal (DI) diversion for weight loss and type 2 diabetes (T2D) resolution. MATERIALS AND METHODS Patients with severe obesity (body mass index (BMI) ≥ 35 kg/m2 with/without T2D (HbA1C ≥ 6.5%)) underwent the study procedure, a side-to-side MS DI diversion, with a standard sleeve gastrectomy (SG). A linear magnet was delivered by flexible endoscopy to a point 250 cm proximal to the ileocecal valve; a second magnet was positioned in the first part of the duodenum; the bowel segments containing magnets were apposed, initiating gradual anastomosis formation. Laparoscopic assistance was used to obtain bowel measurements, obviate tissue interposition, and close mesenteric defects. RESULTS Between November 22 and 26, 2021, 5 female patients (mean weight 117.6 ± 7.1 kg, BMI (kg/m2) 44.4 ± 2.2) underwent side-to-side MS DI + SG. All magnets were successfully placed, expelled without re-intervention, and formed patent durable anastomoses. Total weight loss at 12 months was 34.0 ± 1.4% (SEM); excess weight loss, 80.2 ± 6.6%; and BMI reduction, 15.1. Mean HbA1C (%) dropped from 6.8 ± 0.8 to 4.8 ± 0.2; and glucose (mg/dL), from 134.3 ± 17.9 to 87.3 ± 6.3 (mean reduction, 47.0 mg/dL). There was no anastomotic bleeding, leakage, obstruction, or infection and no mortality. CONCLUSIONS Creation of a side-to-side magnetic compression anastomosis to achieve duodeno-ileostomy diversion in adults with severe obesity was feasible and safe, achieved excellent weight loss, and resolved type 2 diabetes at 1-year follow-up. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05322122.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada.
| | - David Abuladze
- Department of General & Bariatric Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
| | - Levan Koiava
- Department of General & Bariatric Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
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Gagner M, Krinke T, Lapointe-Gagner M, Buchwald JN. Side-to-side duodeno-ileal magnetic compression anastomosis: design and feasibility of a novel device in a porcine model. Surg Endosc 2023:10.1007/s00464-023-10105-x. [PMID: 37170025 DOI: 10.1007/s00464-023-10105-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Minimally invasive metabolic/bariatric surgery (MBS) may be further advanced by magnetic compression anastomosis (MCA) technology. The study aimed to develop a magnet sized to create a patent duodeno-ileostomy (DI) and verify its effectiveness in a porcine model. METHODS Developmental study phase: magnets with 4 different flange-offset dimensions were tested to identify a design that would successfully form a compression anastomosis. Verification phase: evaluation of the selected design's efficacy. In each 6-week phase (4 pigs/phase), one magnet was inserted laparoscopically in the jejunum, one placed gastroscopically in the duodenum. Magnets were aligned, gradually fused, formed an anastomosis, and then detached and were expelled. At necropsy, MCA sites and sutured enterotomy sites were collected and compared. RESULTS Developmental phase: the linear BC42 magnet with a 2.3-mm flange offset design was selected. Verification phase: in 4 swine magnets were mated at the target location, confirmed radiographically. Mean time to magnet detachment 16.0 days (12-22), to expulsion 24.5 days (17-33). MCA was achieved in all animals at time of sacrifice. Animals gained a mean 9.5 kg (3.9-11.8). Specimens revealed patent anastomoses of ≥ 20 mm with smooth mucosa and minimal inflammation and fibrosis compared to sutured enterotomies. One pig underwent corrective surgery for a mesenteric hernia without sequelae. CONCLUSION In a large-animal model, gross and histopathologic examination confirmed that the linear MCA device created a patent, well-vascularized, duodeno-ileal anastomosis. The novel MCA device may be appropriate for use in human MBS procedures.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada.
| | | | - Maxime Lapointe-Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
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Lee WG, Evans LL, Johnson SM, Woo RK. The Evolving Use of Magnets in Surgery: Biomedical Considerations and a Review of Their Current Applications. Bioengineering (Basel) 2023; 10:bioengineering10040442. [PMID: 37106629 PMCID: PMC10136001 DOI: 10.3390/bioengineering10040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The novel use of magnetic force to optimize modern surgical techniques originated in the 1970s. Since then, magnets have been utilized as an adjunct or alternative to a wide array of existing surgical procedures, ranging from gastrointestinal to vascular surgery. As the use of magnets in surgery continues to grow, the body of knowledge on magnetic surgical devices from preclinical development to clinical implementation has expanded significantly; however, the current magnetic surgical devices can be organized based on their core function: serving as a guidance system, creating a new connection, recreating a physiologic function, or utilization of an internal–external paired magnet system. The purpose of this article is to discuss the biomedical considerations during magnetic device development and review the current surgical applications of magnetic devices.
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Affiliation(s)
- William G. Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lauren L. Evans
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sidney M. Johnson
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
| | - Russell K. Woo
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
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19
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Gaidarski III AA, Ferrara M. The Colorectal Anastomosis: A Timeless Challenge. Clin Colon Rectal Surg 2022; 36:11-28. [PMID: 36619283 PMCID: PMC9815911 DOI: 10.1055/s-0042-1756510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal anastomosis is a sophisticated problem that demands an elaborate discussion and an elegant solution. "Those who forget the past are condemned to repeat it." George Santayana, Life of Reason , 1905.
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Affiliation(s)
| | - Marco Ferrara
- Colon and Rectal Clinic of Orlando, Orlando, Florida,Address for correspondence Marco Ferrara, MD Colon and Rectal Clinic of Orlando110 West Underwood ST, Suite A, Orlando, FL 32806
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20
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Steger J, Zimmermann A, Wittenberg T, Mela P, Wilhelm D. Electromagnetic tool for the endoscopic creation of colon anastomoses-development and feasibility assessment of a novel anastomosis compression implant approach. Int J Comput Assist Radiol Surg 2022; 17:2269-2280. [PMID: 36087229 PMCID: PMC9652185 DOI: 10.1007/s11548-022-02722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Colorectal anastomoses are among the most commonly performed interventions in abdominal surgery, while associated patient trauma is still high. Most recent trends of endoscopic anastomosis devices integrate magnetic components to overcome the challenges of minimally invasive surgery. However, the mutual attraction between magnetic implant halves may increase the risk of inadvertently pinching healthy structures. Thus, we present a novel anastomosis device to improve system controllability and flexibility. METHODS A magnetic implant and an applicator with electromagnetic control units were developed. The interaction of magnetic implants with the electromagnets bears particular challenges with respect to the force-related dimensioning. Here, attraction forces must be overcome by the electromagnet actuation to detach the implant, while the attraction force between the implant halves must be sufficient to ensure a stable connection. Thus, respective forces were measured and the detachment process was reproducibly investigated. Patient hazards, associated with resistance-related heating of the coils were investigated. RESULTS Anastomosis formation was reproducibly successful for an implant, with an attraction force of 1.53 [Formula: see text], resulting in a compression pressure of [Formula: see text]. The implant was reproducibly detachable from the applicator at the anastomosis site. Coils heated up to a maximum temperature of [Formula: see text]. Furthermore, we were able to establish a neat reconnection of intestinal bowel endings using our implant. DISCUSSION As we achieved nearly equal compression forces with our implant as other magnetic anastomosis systems did (Magnamosis™: 1.48 N), we concluded that our approach provides sufficient holding strength to counteract the forces acting immediately postoperatively, which would eventually lead to an undesired slipping of the implant halves during the healing phase. Based on heat transfer investigations, preventive design specifications were derived, revealing that the wall thickness of a polymeric isolation is determined rather by stability considerations, than by heat shielding requirements.
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Affiliation(s)
- Jana Steger
- Research Group Minimally-Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum Rechts Der Isar, Technical University of Munich, Trogerstraße 26, 81675 Munich, Germany
- Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, TUM School of Engineering and Design, Technical University of Munich, Garching, Germany
| | - Anne Zimmermann
- Research Group Minimally-Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum Rechts Der Isar, Technical University of Munich, Trogerstraße 26, 81675 Munich, Germany
- Department of Computer Science, Institute of Visual Computing, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Wittenberg
- Department of Computer Science, Institute of Visual Computing, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Petra Mela
- Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, TUM School of Engineering and Design, Technical University of Munich, Garching, Germany
| | - Dirk Wilhelm
- Research Group Minimally-Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum Rechts Der Isar, Technical University of Munich, Trogerstraße 26, 81675 Munich, Germany
- Klinikum Rechts Der Isar, TUM School of Medicine, Clinic and Policlinic for Surgery, Technical University of Munich, Munich, Germany
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Constructing a sound anastomosis. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sterlin A, Evans L, Mahler S, Lindner A, Dickmann J, Heimann A, Sahlabadi M, Aribindi V, Harrison MR, Muensterer OJ. An experimental study on long term outcomes after magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2022; 57:34-40. [PMID: 34656308 DOI: 10.1016/j.jpedsurg.2021.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE Previous studies have shown that a patent, watertight esophageal anastomosis can be accomplished safely using specially-shaped magnets in piglets. However, it is unclear whether such a magnetic esophageal compression anastomosis (MECA) remains patent in the long-term. The purpose of this study was to evaluate the long-term outcome of MECA in an experimental pig model over an observation period of 2 months. METHODS Ten piglets underwent creation of an MECA with custom-made 8 mm magnets and a U-shaped esophageal bypass loop to allow peroral nutrition at eight weeks of life. Two weeks later, the bypass loop was closed surgically, requiring the pigs to swallow via the newly created magnetic compression anastomosis. The pigs were fed soft chow for 2 months. They were monitored for weight gain and signs of dysphagia. At the endpoint of two months, esophagoscopy and contrast esophagography was performed. After removal of the esophagus, the tissues were macroscopiocally and histologically assessed. RESULTS Six piglets survived until the endpoint. In two pigs, closure of the bypass loop failed, these demonstrated mean weight gain of 792 gs/day [95% Confidence interval 575 to 1009 gs/day]. Weight gain in four pigs that exclusively fed via the magnetic anastomosis averaged 577 gs/day [95% confidence interval 434 to 719 gs/day (p = 0.18)]. There were no signs of dysphagia. All magnets passed with the stool within 16 days. After 2 months, a well-formed magnetic compression anastomosis was visible and easily negotiated with a 6.5 mm endoscope. Esophogram and macroscopic findings confirmed patentency of the esophageal anastomoses. Histopathology showed a circular anastomosis lined with contiguous epithelium. CONCLUSION MECA creates a long-term functional and patent anastomosis in pigs. This concept may facilitate minimally-invasive esophageal atresia repair by obviating a technically challenging and time-consuming hand-sewn anastomosis.
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Affiliation(s)
- Alexander Sterlin
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lauren Evans
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Sara Mahler
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Lindner
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jana Dickmann
- Department of Veterinary Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Axel Heimann
- Department of Veterinary Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohammad Sahlabadi
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Vamsi Aribindi
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States; Magnamosis, Inc., San Francisco, California, United States
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, Munich 80337, Germany.
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Muensterer OJ, Evans LL, Sterlin A, Sahlabadi M, Aribindi V, Lindner A, König T, Harrison MR. Novel Device for Endoluminal Esophageal Atresia Repair: First-in-Human Experience. Pediatrics 2021; 148:peds.2020-049627. [PMID: 34615695 DOI: 10.1542/peds.2020-049627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/22/2022] Open
Abstract
Thoracoscopic esophageal atresia (EA) repair affords many benefits to the patient; however, intracorporeal suturing of the anastomosis is technically challenging. Esophageal magnetic compression anastomosis (EMCA) is a compelling option for endoluminal EA repair, but available EMCA devices have prohibitive rates of recalcitrant stricture. Connect-EA is a new endoluminal EMCA device system that employs 2 magnetic anchors with a unique mating geometry designed to reliably create a robust anastomosis and decrease rates of leak and stricture. We describe our first-in-human experience with this novel endoluminal device for staged EA repair in 3 patients (Gross type A, B, and C) at high risk for conventional surgical repair. First, the esophageal pouches were approximated thoracoscopically. After acute tension subsided, the device anchors were endoscopically placed in the esophageal pouches and mated. Anchors were spontaneously excreted in 2 cases. Endoscopic repositioning and retrieval of the anchors were required in 1 patient because of narrowed esophageal anatomy. There were no perioperative complications. Patients were managed for 14 to 18 months. The strictures that developed in the patients were membranous and responded well to dilation alone, resolving after 4 to 5 outpatient dilations. Gastrostomies were closed between 6 and 11 months and all patients are tolerating full oral nutrition. Early experience with this new endoluminal EMCA device system is highly favorable. The device offers considerable benefit over conventional handsewn esophageal anastomosis and anastomotic outcomes are superior to available EMCA devices.
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Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany .,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lauren L Evans
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Alexander Sterlin
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohammad Sahlabadi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Vamsi Aribindi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andreas Lindner
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Tatjana König
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael R Harrison
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
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Trujillo Loli Y, Trejo Huamán MD, Campos Medina S, Vega Landa JI, García Pérez R, Targarona Soler EM. Physical Bases, Indications, and Results of the Use of Magnets in Digestive Surgery: A Narrative Review. J Laparoendosc Adv Surg Tech A 2021; 32:485-494. [PMID: 34492199 DOI: 10.1089/lap.2021.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The use of magnetic devices in digestive surgery has been a matter of debate in recent years. The aim of this review was to describe the physical bases, indications, and results of the use of magnets in digestive surgery. Methods: A review of the literature was performed using Scopus, PubMed, ScienceDirect, and SciELO databases considering as inclusion criteria all articles published since 2007 to date, describing the physical basis of magnetic assisted surgery and those that describe the surgical procedure, including case reports, as well as, articles on humans and experimental animals. Results: Sixty-four studies were included, 15 detailing aspects on the physical basis and 49 about indications and results. Magnets are currently used to perform fixed traction, mobilizing structures, and anastomosis in humans and experimental animals. Conclusions: The use of magnets in digestive surgery has shown good results, and no complications arising from their use have been reported. However, more prospective and randomized studies that compare magnetic surgery and conventional techniques are needed.
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Affiliation(s)
- Yeray Trujillo Loli
- Universidad Nacional Mayor de San Marcos, Lima, Peru.,Department of Surgery, Daniel Alcides Carrion National Hospital, Callao, Peru
| | | | | | | | | | - Eduardo María Targarona Soler
- Department of General and Digestive Surgery, Unit Hospital de la Santa Creu I Sant Pau, Universidad Autonoma de Barcelona, Barcelona, Spain
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Marchegiani F, Noll E, Riva P, Kong SH, Saccomandi P, Vita G, Lindner V, Namer IJ, Marescaux J, Diemunsch P, Diana M. Effects of Warmed and Humidified CO 2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis. Surg Innov 2021; 28:7-17. [PMID: 33095686 DOI: 10.1177/1553350620967225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background. Pneumoperitoneum insufflation with warmed and humidified carbon dioxide (WH-CO2) can prevent heat loss and increase tissue oxygenation. We evaluated the impact of localized WH-CO2 insufflation on the anastomotic healing process. Methods. Sixty male Wistar rats were randomized: Group 1 (control, n = 12), Group 2 (cold and dry CO2, CD-CO2, n = 24), and Group 3 (WH-CO2, n = 24). A magnetic compression side-to-side colonic anastomosis was performed under 60-minute local abdominal CO2 flow insufflation. Animal temperature was recorded. IL-1, IL-6, and CRP levels were assessed before and after insufflation and on postoperative day (POD) 7 and POD 10. Endoscopic follow-up was performed on POD 7 and POD 10. A burst pressure (BP) test of the specimen was performed on POD 10, and histopathological analysis was then performed. Metabolomics of the anastomotic site was determined. Results. Seven rats (5 CD-CO2 group, 1 WH-CO2 group, and 1 control group) died during the survival period. Necropsies revealed intestinal occlusions (n = 2). One additional rat from the CD-CO2 group was sacrificed on POD 7 due to intestinal perforation. The postoperative course was uneventful in the remaining cases. There was no difference in BP among the groups. Thermal monitoring confirmed that WH-CO2 insufflation was effective to reduce heat loss. IL-1 levels were statistically and significantly lower on POD 10 in the WH-CO2 group than the CD-CO2 group but not lower than the control group. CRP levels, histopathology, and metabolomics did not show any difference between the 3 groups. Conclusions. WH-CO2 was effective to preserve core temperature. However, it did not improve anastomotic healing.
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Affiliation(s)
- Francesco Marchegiani
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Eric Noll
- Anesthesiology and Intensive Care Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Pietro Riva
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Seong-Ho Kong
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Paola Saccomandi
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Giorgia Vita
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Véronique Lindner
- Pathology Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Izzie Jacques Namer
- Membrane Biophysics Laboratory and Nuclear Medicine Chemistry Institute, 27083University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Pierre Diemunsch
- Anesthesiology and Intensive Care Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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Endoscopic gastrointestinal anastomosis: a review of established techniques. Gastrointest Endosc 2021; 93:34-46. [PMID: 32593687 DOI: 10.1016/j.gie.2020.06.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023]
Abstract
Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create GI anastomosis without requiring surgery. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreatobiliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreatobiliary symptoms in afferent loop syndrome. Endoscopic GI anastomosis is less invasive and less expensive than surgical approaches, result in improved outcomes, and therefore are more appealing to patients and providers. The aim of this review is to present the evolution of luminal endoscopic gastroenteric and enteroenteric anastomosis dating back to the first compression devices and to describe the clinical techniques being used today, such as magnets, natural orifice transluminal endoscopic surgery, and EUS-guided techniques. Through continued innovation, endoscopic interventions will rise to the forefront of the therapeutic arsenal available for patients requiring GI anastomosis.
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Kamada T, Ohdaira H, Takeuchi H, Takahashi J, Ito E, Suzuki N, Narihiro S, Yoshida M, Yamanouchi E, Suzuki Y. New Technique for Magnetic Compression Anastomosis Without Incision for Gastrointestinal Obstruction. J Am Coll Surg 2020; 232:170-177.e2. [PMID: 33190786 DOI: 10.1016/j.jamcollsurg.2020.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a novel technique of anastomosis similar to that with surgery, but in a minimally invasive manner. Few reports are available on the utility and feasibility of MCA for gastrointestinal anastomosis without requiring general anesthesia in humans, owing to the difficulty of delivering magnets. We evaluated the safety, efficacy, and feasibility of MCA in gastrointestinal obstruction without requiring general anesthesia. STUDY DESIGN In this retrospective single-center study, patients who underwent MCA from January 2013 to October 2019 were included. Adult patients with gastrointestinal obstruction or stenosis, irrespective of the underlying disease, with severe comorbidities, complicated abdominal surgical history, or postoperative complications, and who were unable to tolerate surgery, were eligible for inclusion. Two magnets were delivered by a combination of endoscopic and fluoroscopic procedures and placed in the lumen of the organ to be anastomosed. The main outcome was the technical success of MCA. RESULTS Fourteen patients underwent MCA, and the technical success of MCA was achieved in 100% of the cases. The mean procedural time, duration for anastomosis formation, and postoperative hospital stay were 44 minutes, 13 days, and 36 days, respectively. Two patients underwent anastomotic restenosis, and 1 patient had an anastomotic perforation due to balloon dilatation to prevent restenosis. The mean follow-up period was 34 months. CONCLUSIONS MCA without general anesthesia for gastrointestinal anastomosis is safe, useful, and feasible. MCA can be a valuable alternative to surgery in gastrointestinal obstruction.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Hideyuki Takeuchi
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Satoshi Narihiro
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Iguchi, Nasushiobara City, Tochigi, Japan
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Liu S, Lv Y. Constant magnetic field in treating congenital esophageal and anorectal malformation: a review. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000130. [DOI: 10.1136/wjps-2020-000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundCongenital esophageal and anorectal malformation are common in neonates. Refractory esophageal anastomotic stricture and abnormal defecation after surgical correction in infants are challenging surgical problems. Magnetic compression anastomosis (MCA) using mated magnets with their interposed compressed tissue may result in serosa-to-serosa apposition.Data sourcesA literature search was performed to establish an algorithm for these accidents by the authors to identify relevant articles published from 1977 to 2019 in Google, Medline, ISI Web of Knowledge Ovid, CNKI and library document delivery, using search terms “magnetics”, “esophageal malformation”, “anorectal” and “perforation”. A total of 24 literatures were collected.ResultsMagnamosis is technically feasible for alimentary tract anastomoses in pediatric patients. The magnets are most commonly made of neodymium–iron–boron and samarium–cobalt alloys, which have been employed to create solid anastomosis for long-gap esophageal atresia and refractory esophageal stricture without thoracotomy in children in recent years. Furthermore, magnamosis can be used for the functional undiversion of ileostomy. In anorectal malformations with favorable anatomy, this procedure may avoid an operative repair such as posterior sagittal reconstruction.ConclusionTranslumenal anastomosis of digestive tract using the MCA is a reliable, minimally invasive and feasible method to treat congenital esophageal and anorectal malformation.
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Wolfe E, Zidane M, Hancock BJ, Lum Min SA, Zaritzky M, Keijzer R. Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations. J Pediatr Surg 2020; 55:821-823. [PMID: 32061365 DOI: 10.1016/j.jpedsurg.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Magnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. METHODS Our center treated the first 3 cases of EA ± TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ± TEF treated between 1991 and 2015. The controls had EA ± TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann-Whitney U tests were used with p < 0.05 being significant. RESULTS The 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). CONCLUSION Our results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Emma Wolfe
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mazen Zidane
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Betty Jean Hancock
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mario Zaritzky
- Department of Radiology, Division of Pediatric Radiology, University of Chicago, Chicago, IL, USA
| | - Richard Keijzer
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
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Endoscopic Magnetic Compression Anastomosis For Small Bowel Bypass in a High Operative Risk Setting. Surg Laparosc Endosc Percutan Tech 2020; 29:e84-e87. [PMID: 31107851 DOI: 10.1097/sle.0000000000000669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The endoscopic enteroenteral bypass could revolutionize the treatment of small bowel obstruction (SBO) in inoperable patients. We describe the technique of endoscopic delivery of a magnetic compression anastomosis device and the creation of an enteroenteral anastomosis in a patient with recurrent acute on chronic SBOs and prohibitively high operative risk. In this novel procedure, a magnetic compression anastomosis device is delivered on either side of the obstruction using a hybrid endoscopic/fluorographic technique, effectively bypassing the obstruction and relieving symptoms. The anastomosis was endoscopically evaluated at regular intervals postprocedure. By 7 days, healthy villi were visible through the mated magnetic rings. By 10 days, the anastomosis was widely patent. The rings passed through the ileostomy and were evacuated, and the patient's symptoms completely resolved. The anastomosis remained widely patent at 1 year. In summary, this case demonstrates the benefit of magnetic compression anastomosis in a patient with SBO and high operative risk.
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Hu B, Ye LS. Endoscopic applications of magnets for the treatment of gastrointestinal diseases. World J Gastrointest Endosc 2019; 11:548-560. [PMID: 31839874 PMCID: PMC6885730 DOI: 10.4253/wjge.v11.i12.548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic treatment of gastrointestinal diseases has developed rapidly in recent years, due to its minimally invasive nature. One of the main contributing factors for this progress is the improvement of endoscopic instruments, which are essential for facilitating safe and effective endoscopic interventions. However, the slow learning curve required in the implementation of many advanced endoscopic procedures using standard devices is associated with a high risk of complications. Other routine procedures may also be complicated by unexpected difficulties. Based on the ferromagnetic properties of many objects, both internal and external magnetic devices have been developed and applied for multiple endoscopic interventions. The applications of magnets, mainly including compression, anchoring and traction, facilitate many difficult procedures and make it feasible to operate procedures that were previously impossible. Other novel endoscopic applications, such as magnetic nanoparticles, are also under development. In this article, we reviewed published studies of endoscopic applications of magnets for the treatment of gastrointestinal diseases such as precancerous lesions and cancer, obstruction, stricture, congenital and acquired malformations, motility disorders, and ingestion of foreign bodies. Since several endoscopic applications of magnets may also be relevant to surgery, we included them in this review.
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Affiliation(s)
- Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Matsuzaki I, Hattori M, Yamauchi H, Goto N, Iwata Y, Yokoi T, Tsunemi M, Kobayashi M, Yamamura T, Miyahara R. Magnetic anchor-guided endoscopic submucosal dissection for colorectal tumors (with video). Surg Endosc 2019; 34:1012-1018. [DOI: 10.1007/s00464-019-07127-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
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Hybrid fluorescent magnetic gastrojejunostomy: an experimental feasibility study in the porcine model and human cadaver. Surg Endosc 2019; 34:1393-1400. [PMID: 31317330 DOI: 10.1007/s00464-019-06963-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
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Zhao G, Yan X, Ma L, Liu W, Zhang J, Guo H, Liu Y, Lv Y. Biomechanical and Performance Evaluation of Magnetic Elliptical-Ring Compressive Anastomoses. J Surg Res 2019; 239:52-59. [PMID: 30802705 DOI: 10.1016/j.jss.2019.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/20/2018] [Accepted: 01/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND After magnetic compressive anastomosis, anastomat passage through the narrow channels of the digestive tract is difficult owing to the device's large volume. Such passage can lead to mechanical damage to the digestive tract or anastomat's unstable excretion time. This article presents a new magnetic compressive anastomotic approach. METHODS A magnetic elliptical-ring compressive anastomat was designed and evaluated for placement and passage in vitro. Nine young adult dogs underwent laparotomy with intestinal tissue side-to-side anastomosis. Four different groups of magnetic compressive anastomats of two different magnetic force levels (20 N or 30 N) and shapes (round or elliptical) were implanted into each dog simultaneously. Three dogs were euthanized on each of postoperative day 1, day 4, and day 7. Anastomoses were then compared with respect to histology and tensile fracture force. RESULTS The magnetic elliptical-ring compressive anastomat was functional but produced less obstruction compared to its round counterpart during passage through the esophagus and intestine. Nine dogs underwent successful surgery and harvesting of 30 total anastomoses. Histology of anastomotic tissue showed that, along the newly formed tunnel connecting the two sides of anastomotic tissues, compressed tissues became thinner and fell off, and initial anastomoses formed on the seventh postoperative day. There were large differences in tensile fracture force among the anastomoses formed by magnets with different magnetic forces of the same structure. However, the magnetic compressive anastomat structure did not affect anastomotic repair during magnetic compression anastomosis. CONCLUSIONS The magnetic elliptical-ring compressive anastomat is an efficient anastomotic device that can be used easily and with good passage. The device has good biomechanical properties and can be used with endoscopy to reduce operative time.
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Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Lei Ma
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenyan Liu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Hongchang Guo
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yaxiong Liu
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China.
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Jang SI, Lee KH, Joo SM, Park H, Choi JH, Lee DK. Maintenance of the fistulous tract after recanalization via magnetic compression anastomosis in completely obstructed benign biliary stricture. Scand J Gastroenterol 2019; 53:1393-1398. [PMID: 30351979 DOI: 10.1080/00365521.2018.1526968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study compared the efficacy of a percutaneous transhepatic cholangioscopy (PTCS) catheter and a fully covered self-expandable metal stent (FCSEMS) for maintaining biliary tract patency after magnetic compression anastomosis (MCA). METHODS This study included patients with completely obstructed benign biliary stricture (BBS), which was resolved by MCA and subsequent insertion of a PTCS catheter or FCSEMS. We compared the restenosis-free time after removal of the PTCS catheter or FCSEMS, and the rate of complications. RESULTS A total of 49 patients were analyzed. The mean ages of the patients in these groups were 50.1 and 49.6 years, respectively. The predisposing conditions causing complete BBS were liver transplantation (n = 38), abdominal surgery (n = 10) and trauma (n = 1). The mean indwelling durations were 176 and 128 days in the PTCS catheter and FCSEMS groups, respectively. The mean follow-up duration after removal of the PTCS catheter and FCSEMS were 2259 and 680.5 days, respectively. Three patients in the PTCS group and three patients in the FCSEMS group experienced stricture relapse. The mean duration between recurrence and stent removal were 924 and 265 days, respectively, and the numbers of stricture-free days did not differ significantly between the two groups. The adverse event rate did not differ significantly between the PTCS and FCSEMS groups (50% vs. 24.2%, respectively). CONCLUSIONS FCSEMSs have an efficacy and safety similar to those of PTCS catheters for maintaining biliary tract patency after MCA, but are more convenient for patients.
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Affiliation(s)
- Sung Ill Jang
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Kwang-Hun Lee
- b Department of Radiology , Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Seung-Moon Joo
- b Department of Radiology , Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Hyunsung Park
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Jung Hye Choi
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Dong Ki Lee
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
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Bruns NE, Glenn IC, Craner DR, Schomisch SJ, Harrison MR, Ponsky TA. Magnetic compression anastomosis (magnamosis) in a porcine esophagus: Proof of concept for potential application in esophageal atresia. J Pediatr Surg 2019; 54:429-433. [PMID: 30309731 DOI: 10.1016/j.jpedsurg.2018.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Magnetic compression anastomosis (magnamosis) is the process of forming a sutureless anastomosis of the gastrointestinal tract using two magnetic Harrison rings. It has been shown to be effective in stomach, small bowel and colon, but has not been implemented in the esophagus. A pure esophageal atresia porcine model was developed to test the concept. METHODS Five pigs weighing between 35 and 65 kg were used. In all pigs, a percutaneous endoscopic gastrostomy (PEG) tube was placed, and a right thoracotomy was performed. Esophageal atresia was simulated by transecting the esophagus with a cutting stapler, and magnets were placed endoscopically to approximate the two ends of the esophagus. In the first pig, the tissue within the magnetic ring was excised endoscopically to achieve immediate patency. In the second pig, approximation of the blind esophageal ends was reinforced with 3-4 externally-placed sutures but immediate patency was not performed. In the last three pigs, both external suture reinforcement and immediate patency were performed. The pigs survived for 10-14 days and received nutrition through PEG tube. At necropsy, an esophagram was performed, the specimen was explanted and a leak test was performed. RESULTS The first pig died in the early postoperative period from a leak owing to separation of the magnets. The second pig died from aspiration before the anastomosis formed. The last three pigs survived until the study endpoint. The third pig had a contained leak owing to the staple line being placed between the magnets; this was not clinically significant. The last two pigs had well-formed anastomoses. Burst tests showed no leak when injecting saline up to 30 mmHg. CONCLUSION Magnamosis is technically feasible for esophagoesophageal anastomoses. A survival model for pure esophageal atresia was developed and refined in pigs. Further work in this area may lead to clinical use in humans.
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Affiliation(s)
- Nicholas E Bruns
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH.
| | - Ian C Glenn
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | - Domenic R Craner
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | - Steve J Schomisch
- Department of Surgery, Case Western Reserve University, Cleveland, OH
| | - Michael R Harrison
- Division of Pediatric Surgery, University of California, San Francisco, San Francisco, California
| | - Todd A Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
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Diaz R, Davalos G, Welsh LK, Portenier D, Guerron AD. Use of magnets in gastrointestinal surgery. Surg Endosc 2019; 33:1721-1730. [PMID: 30805789 DOI: 10.1007/s00464-019-06718-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic and endoscopic surgery has undergone vast progress during the last 2 decades, translating into improved patient outcomes. A prime example of this development is the use of magnetic devices in gastrointestinal surgery. Magnetic devices have been developed and implemented for both laparoscopic and endoscopic surgery, providing alternatives for retraction, anchoring, and compression among other critical surgical steps. The purpose of this review is to explore the use of magnetic devices in gastrointestinal surgery, and describe different magnetic technologies, current applications, and future directions. METHODS IRB approval and written consent were not required. In this review of the existing literature, we offer a critical examination at the use of magnets for gastrointestinal surgery currently described. We show the experiences done to date, the benefits in laparoscopic and endoscopic surgery, and additional future implications. RESULTS Magnetic devices have been tested in the field of gastrointestinal surgery, both in the contexts of animal and human experimentation. Magnets have been mainly used for retraction, anchoring, mobilization, and anastomosis. CONCLUSION Research into the use of magnets in gastrointestinal surgery offers promising results. The integration of these technologies in minimally invasive surgery provides benefits in various procedures. However, more research is needed to continually evaluate their impact and implementation into surgical practice.
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Affiliation(s)
- Ramon Diaz
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Gerardo Davalos
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Leonard K Welsh
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Dana Portenier
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Alfredo D Guerron
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA.
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Yang L, Lu J, Wang Y, Zhang M, Shi Y, Wei S, Liu P, Wu Z, Lv Y, Wu R. A Rat Model of Orthotopic Liver Transplantation Using a Novel Magnetic Anastomosis Technique for Suprahepatic Vena Cava Reconstruction. J Vis Exp 2018:56933. [PMID: 29608158 PMCID: PMC5931784 DOI: 10.3791/56933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The rat model of orthotopic liver transplantation (OLT) is essential for transplant research. It is a very sophisticated animal model and requires a steep learning curve. The introduction of the cuff technique for anastomosis of the portal vein (PV) and infrahepatic vena cava (IHVC) has significantly simplified the transplant procedure in rats. However, due to the short anterior wall of the recipients' suprahepatic vena cava (SHVC), the cuff technique is very difficult to use for the reconstruction of the SHVC. Most researchers in this field still use the hand-suture technique for SHVC reconstruction, which makes it the bottleneck step in rat orthotopic liver transplantation. The magnetic anastomosis technique (i.e., magnamosis) is a method of connecting two vessels using the attractive force between two magnets. Our recent study has shown that the magnetic anastomosis technique is superior to the hand-suture technique for SHVC reconstruction in rats. In this article, we show a step-by-step protocol for SHVC reconstruction in rats using the novel magnetic anastomosis technique. In this model, the reconstruction of the PV and IHVC was performed by the standard cuff technique, while the reconstruction of the bile duct (BD) was performed by a stent technique. The hepatic re-arterialization was not performed. The magnetic anastomosis technique made SHVC reconstruction much easier and significantly shortened the anphepatic phase. After a reasonable learning curve, even researchers without advanced microsurgical skills can produce reliable and reproducible results using this rat model of OLT.
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Affiliation(s)
- Lifei Yang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University
| | - Jianwen Lu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Yue Wang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Mei Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Yuan Shi
- Organ Transplantation Center, Tianjin First Center Hospital
| | - Shasha Wei
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University
| | - Peng Liu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Yi Lv
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University
| | - Rongqian Wu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University; Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital, Xi'an Jiaotong University;
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Graves CE, Co C, Hsi RS, Kwiat D, Imamura-Ching J, Harrison MR, Stoller ML. Magnetic Compression Anastomosis (Magnamosis): First-In-Human Trial. J Am Coll Surg 2017; 225:676-681.e1. [DOI: 10.1016/j.jamcollsurg.2017.07.1062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 01/28/2023]
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Zhang H, Xue F, Zhang J, Liu W, Dong D, Zhu H, Wu R, Lv Y. A novel magnetic device for laparoscopic cholangiojejunostomy. J Surg Res 2017; 218:271-276. [PMID: 28985860 DOI: 10.1016/j.jss.2017.05.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/28/2017] [Accepted: 05/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic cholangiojejunostomy (LCJ) with hand-sewn technique is technically difficult and requires a long time to master. The purpose of this study was to assess the feasibility of LCJ using a novel magnetic compression device (MCD) in dogs. METHODS The concept of the purse-string technique of the circular stapler was used to design a novel MCD for LCJ. To test the feasibility of this MCD in a more clinically relevant situation, four dogs were subjected to bile duct ligation. When the diameter of their bile ducts reached 10 mm, LCJ using MCD was performed. The anastomotic time and expelling time of the magnets were assessed. RESULTS In the clinically relevant model of bile duct obstruction in dogs, LCJ created with this MCD yielded patent anastomoses. The LCJ procedure using this novel MCD was simple, and the mean anastomotic time was 12.9 ± 1.73 min. All animals recovered smoothly after the operation without complications. All magnets spontaneously passed through the rectum in 14.5 ± 2.08 d after LCJ. CONCLUSIONS LCJ in dogs using this novel MCD is feasible.
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Affiliation(s)
- Hongke Zhang
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Fei Xue
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Jing Zhang
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Wenyan Liu
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Dinghui Dong
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Haoyang Zhu
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Rongqian Wu
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Yi Lv
- Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China.
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Ryou M, Agoston AT, Thompson CC. Endoscopic intestinal bypass creation by using self-assembling magnets in a porcine model. Gastrointest Endosc 2016; 83:821-5. [PMID: 26522371 DOI: 10.1016/j.gie.2015.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS A purely endoluminal method of GI bypass would be desirable for the treatment of obstruction, obesity, or metabolic syndrome. We have developed a technology based on miniature self-assembling magnets that create large-caliber anastomoses (Incisionless Anastomosis System [IAS]). The aim of this study was to evaluate procedural characteristics of IAS deployment and long-term anastomotic integrity and patency. METHODS We performed a 3-month survival study of Yorkshire pigs (5 interventions, 3 controls). Intervention pigs underwent simultaneous enteroscopy/colonoscopy performed with the animals under intravenous sedation. The IAS magnets were deployed and coupled with reciprocal magnets under fluoroscopy. Every 3 to 6 days pigs underwent endoscopy until jejunocolonic anastomosis (dual-path bypass) creation and magnet expulsion. Necropsies and histological evaluation were performed. The primary endpoints were technical success; secondary endpoints of anastomosis integrity, patency, and histological characteristics were weight trends. RESULTS Under intravenous sedation, endoscopic bypass creation by using IAS magnets was successfully performed in 5 of 5 pigs (100%). Given porcine anatomy, the easiest dual-path bypass to create was between the proximal jejunum and colon. The mean procedure time was 14.7 minutes. Patent, leak-free anastomoses formed by day 4. All IAS magnets were expelled by day 12. All anastomoses were fully patent at 3 months with a mean diameter of 3.5 cm. The mean 3-month weight was 45 kg in bypass pigs and 78 kg in controls (P = .01). At necropsy, adhesions were absent. Histology showed full re-epithelialization across the anastomosis without fibrosis or inflammation. CONCLUSION Large-caliber, leak-free, foreign body-free endoscopic intestinal bypass by using IAS magnets can be safely and rapidly performed in the porcine by model using only intravenous sedation.
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Affiliation(s)
- Marvin Ryou
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A Tony Agoston
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Arun A, Gaston B, Kwiat D, Imamura-Ching J, Fechter R, Chen S, Jiang H, Harrison M, Roy S. Inductive Sensing to Detect Tissue Thickness Between Magnets for Potential Application in Magnetic Compression Based Anastomosis. J Med Device 2016. [DOI: 10.1115/1.4032615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Magnetic compression based anastomoses use magnetic force to necrose tissue between two magnets to create an anastomosis. Nickel-plated neodymium–iron–boron magnets are used in our study. The compression pressure between the magnets depends on the distance between the magnets, which is determined by the thickness of the compressed tissue and depends on bowel wall thickness and elasticity. It is critical to know the distance between the magnets once the tissue is compressed because the magnets must be within a critical distance of each other in order to create enough compressive force to necrose the tissue. We have developed an inductance sensor to detect the distance (tissue thickness) between the two magnets after the surgeon has deployed them. Inductance sensing is a contact-less sensing method that enables precise short-range detection of conducting surfaces. The inductor coil mounted on one magnet detects the second magnet by measuring the change in inductance due to eddy current induced on the nickel-plated surface of the second magnet. The change in the inductance is proportional to the change in distance between the magnets. The sensor was first calibrated by using polycarbonate sheets to simulate the intestine tissue. We are able to detect up to 6 mm of spacing between the magnets. Pig intestine from Yorkshire pigs was used to characterize the sensor. We are able to distinguish up to five distinct layers of the intestine from the large intestine. This sensing mechanism can indicate the operating surgeon the exact thickness of the tissue compressed between the two magnets. The surgeon can thus be sure of formation of a clean anastomosis and avoid the likelihood of the magnets sliding away or uncoupling.
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Affiliation(s)
- Anupama Arun
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143 e-mail:
| | - Brandon Gaston
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Dillon Kwiat
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Jill Imamura-Ching
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Richard Fechter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Shijie Chen
- School of Electrical Engineering, San Francisco State University, San Francisco, CA 94132
| | - Hao Jiang
- School of Electrical Engineering, San Francisco State University, San Francisco, CA 94132
| | - Michael Harrison
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143
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Minimally invasive entero-enteral dual-path bypass using self-assembling magnets. Surg Endosc 2016; 30:4533-8. [PMID: 26895911 DOI: 10.1007/s00464-016-4789-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A minimally invasive method of entero-enteral bypass may be desirable for treatment of obstruction, obesity, or metabolic syndrome. We have developed a technology based on miniature self-assembling magnets which create large-caliber anastomoses (incisionless anastomosis system or IAS). The aim of this study was to assess (a) procedural characteristics of IAS deployment and (b) long-term integrity and patency of the resulting jejuno-ileal dual-path bypass. METHODS Endoscopic jejuno-ileal bypass creation using IAS magnets was performed in 8 Yorkshire pigs survived 3 months. PROCEDURE The jejunal magnet was endoscopically deployed. However, the ileal magnet required surgical delivery given restraints of porcine anatomy. A 5-mm enterotomy was created through which the ileal magnet was inserted using a modified laparoscopic delivery tool. Magnets were manually coupled. Pigs underwent serial endoscopies for anastomosis assessment. Three-month necropsies were performed, followed by pressure testing of anastomoses and histological analysis. RESULTS Jejuno-ileal bypass creation using self-assembling IAS magnets was successful in all 8 pigs (100 %). Patent, leak-free bypasses formed in all animals by day 10. All IAS magnets were expelled by day 12. Anastomoses were widely patent at 3 months, with mean maximal diameter of 30 mm. At necropsy, adhesions were minimal. Pressure testing confirmed superior integrity of anastomotic tissue. Histology showed full epithelialization across the anastomosis with no evidence of submucosal fibrosis or inflammation. CONCLUSIONS Entero-enteral bypass using self-assembling IAS magnets is safe and technically feasible in the porcine model. IAS magnets can be rapidly delivered endoscopically or through a modified laparoscopic device. Expulsion of fused magnets avoids retention of prosthetic material. Anastomoses are widely patent and fully re-epithelialized. Three-month pressure testing reveals anastomotic tissue to be as robust as native tissue, while necropsy and histology suggests minimal/absent tissue inflammation. In human anatomy, a fully endoscopic jejuno-ileal bypass using IAS magnets may be feasible.
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Rahman I, Patel P, Boger P, Thomson M, Afzal NA. Utilisation of magnets to enhance gastrointestinal endoscopy. World J Gastrointest Endosc 2015; 7:1306-1310. [PMID: 26722611 PMCID: PMC4689792 DOI: 10.4253/wjge.v7.i19.1306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/08/2015] [Accepted: 11/17/2015] [Indexed: 02/05/2023] Open
Abstract
Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice.
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Magnets for therapy in the GI tract: a systematic review. Gastrointest Endosc 2015; 82:237-45. [PMID: 25936447 DOI: 10.1016/j.gie.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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Xu ZF, Li ZJ, Sun YL, Zheng Y, Shi HY, Zhen YN, Wang B, Niu HX, Wang RG. A novel spherical magnetic compression device for colorectal anastomosis in a Swine model. J Laparoendosc Adv Surg Tech A 2015; 25:323-9. [PMID: 25853183 DOI: 10.1089/lap.2014.0404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We designed a novel, spherical magnetic compression colorectal anastomosis device and established a swine model to assess the feasibility and safety, as well as advantages, of the device. METHODS AND MATERIALS Fifteen animals were divided into five groups (sacrificed on Days 3, 5 7, 9, and 14) with 3 in each group. In each group, a magnetic compression device was used in 2 animals (experimental animals), and a stapled device was used in 1 animal (control animal). Feeding status, bowel movements, the discharge time of the magnetic anastomosis device, burst pressure, and magnetic field strength were recorded. Gross anatomical and histological examinations were performed. RESULTS The average device discharge time was 7.5 days. The burst pressure increased over time for both the experimental and control animals. Both the gross anatomical and histological examinations suggested that the inflammatory reaction was milder. Healing occurred more quickly, and the incidence of complications was lower for the experimental animals than for the control animals. CONCLUSIONS The potential benefits of the spherical magnetic compression colorectal anastomosis device, relative to the stapled device, were in terms of effectiveness and complication incidence, which encourages us to further study its application in gastrointestinal anastomosis.
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Affiliation(s)
- Zhong-fa Xu
- 1 Department of Colorectal Cancer Surgery, Shandong Cancer Hospital , Jinan, China
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Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27:239-49. [PMID: 24905938 DOI: 10.1111/den.12319] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Abstract
Endoscopic and percutaneous procedures have shown high success rates when used to treat benign biliary stricture. However, cases in which a guidewire cannot be passed through a refractory stricture or a complete obstruction are difficult to treat using conventional methods. Magnetic compression anastomosis (MCA) has emerged as a non-surgical alternative avoiding operational mortality and morbidity. The feasibility and safety of MCA have been experimentally and clinically verified in cases of biliobiliary and bilioenteric anastomosis. However, no pre-MCA assessment modality capable of predicting outcomes is as yet available, and no universally effective magnet delivery method has as yet been established, rendering it difficult to identify patients for whom MCA is appropriate. Various experimental studies seeking to overcome these limitations are underway. Such work will improve our in-depth understanding of MCA, which has been trialed in various fields. Upon further development, MCA may become a ground-breaking option for treatment of benign strictures that are difficult to resolve using conventional methods, and MCA may be expected to be minimally traumatic and highly effective. The aim of the present study was to discuss the current status of MCA and the direction of MCA development by reviewing clinical and experimental MCA data.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Jose RR, Raja WK, Ibrahim AMS, Koolen PGL, Kim K, Abdurrob A, Kluge JA, Lin SJ, Beamer G, Kaplan DL. Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink. J Biomed Mater Res B Appl Biomater 2014; 103:1333-43. [PMID: 25385518 DOI: 10.1002/jbm.b.33312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/28/2014] [Accepted: 10/10/2014] [Indexed: 01/03/2023]
Abstract
Sutureless anastomosis devices are designed to reduce surgical time and difficulty, which may lead to quicker and less invasive cardiovascular anastomosis. The implant uses a barb-and-seat compression fitting composed of one male and two female components. The implant body is resorbable and capable of eluting heparin. Custom robotic deposition equipment was designed to fabricate the implants from a self-curing silk solution. Curing did not require deleterious processing steps but devices demonstrated high crush resistance, retention strength, and leak resistance. Radial crush resistance is in the range of metal vascular implants. Insertion force and retention strength of the anastomosis was dependent on fit sizing of the male and female components and subsequent vessel wall compression. Anastomotic burst strength was dependent on the amount of vessel wall compression, and capable of maintaining higher than physiological pressures. In initial screening using a porcine implant, the devices remained intact for 28 days (the length of study). Histological sections revealed cellular infiltration within the laminar structure of the male component, as well as at the interface between the male and female components. Initial degradation and absorption of the implant wall were observed. The speed per anastomosis using this new device was much faster than current systems, providing significant clinical improvement.
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Affiliation(s)
- Rod R Jose
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Waseem K Raja
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Pieter G L Koolen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Kuylhee Kim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Abdurrahman Abdurrob
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Jonathan A Kluge
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Gillian Beamer
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts Clinical and Translational Science Institute, Tufts University, Grafton, MA 01536
| | - David L Kaplan
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
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Matsuzaki I, Miyahara R, Hirooka Y, Funasaka K, Furukawa K, Ohno E, Nakamura M, Kawashima H, Maeda O, Watanabe O, Ando T, Kobayashi M, Goto H. Simplified magnetic anchor-guided endoscopic submucosal dissection in dogs (with videos). Gastrointest Endosc 2014; 80:712-716. [PMID: 25085334 DOI: 10.1016/j.gie.2014.05.334] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) was developed to reduce adverse events such as bleeding and perforation and to facilitate ESD. However, the external electromagnet required miniaturization to make it suitable for daily clinical practice. OBJECTIVE To evaluate the feasibility of simplified MAG-ESD using permanent magnets. DESIGN Case series. SETTING Nagoya University Hospital. SUBJECTS Beagle dogs. INTERVENTIONS The simplified MAG-ESD was performed on 10 representative areas of the stomachs of beagle dogs. The magnetic anchor consisted of an internal magnet attached to a hemoclip. The external and internal magnets were made from the rare earth neodymium. MAIN OUTCOME MEASUREMENTS The feasibility of countertraction with good visualization using simplified MAG-ESD. The rate of perforation, the time required for preparation, and attaching the magnetic anchor were also evaluated. RESULTS All lesions were successfully resected without perforation. The magnetic anchor could be controlled easily, and direct visualization was maintained by adequate counter traction. Preparing the magnetic anchor and grasping the mucosal edge using the hemoclip was easy and required a median of only 4 minutes (range, 2-7 minutes). LIMITATIONS Animal experiment, low number and lesion size. CONCLUSIONS This simplified MAG-ESD is feasible and allowed excellent visualization in the dog stomach. The feasibility of this system should be assessed in humans.
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Affiliation(s)
- Ippei Matsuzaki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Kohei Funasaka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Watanabe
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ando
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
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