Magnetic pancreaticobiliary stents and retrieval system: Obviating the need for repeat endoscopy (with video)
Division of Gastroenterology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Gastrointestinal endoscopy
(Impact Factor: 5.37).
01/2012; 75(4):888-892.e1. DOI: 10.1016/j.gie.2011.09.051
Plastic stents are routinely placed in the pancreaticobiliary system to facilitate drainage. A second endoscopy is often required for stent removal. We have developed magnetic pancreaticobiliary stents that can be removed by using an external hand-held magnet, thereby obviating the need for a second endoscopy.
To develop and test magnetic pancreaticobiliary stents and retrieval system in ex-vivo and in-vivo porcine models.
Benchtop and animal study.
Design: Computer simulations determined both the optimal design of cylindrical magnets attached to the distal aspect of existing plastic stents and the optimal design of the external hand-held magnet. Benchtop ex-vivo experiments measured magnetic force to validate the design. In-vivo analysis: In 5 Yorkshire pigs, magnetic stents were deployed into the common bile duct by using a conventional duodenoscope. An external hand-held magnet was applied for stent removal. Stent insertion and removal times were recorded.
Magnetic stents of varying lengths and calibers were successfully created. In ex-vivo testing, the capture distance was 10.0 cm. During in-vivo testing, the magnetic stents were inserted and removed easily. The mean insertion and removal times were 3.2 minutes and 33 seconds, respectively.
Animal study, small numbers.
Magnetic pancreaticobiliary stents and associated retrieval system were successfully designed and tested in the acute porcine model. An external, noninvasive means of stent removal potentially obviates the need for a second endoscopy, which could represent a major gain both for patients and in health care savings.
Available from: Josef Tugwell
- "This work has been demonstrated in vitro via a plastic phantom and in vivo in the porcine model . Other work includes that of the Development Endoscopy Laboratory at Harvard who have demonstrated removal of pancreatic and biliary stents in pigs by means of magnetic coupling , . Kume et al. demonstrated porcine laparoscopic cholecystectomy  and colonic resection  with the aid of magnetic retraction. "
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ABSTRACT: The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet off when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a centre lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in trans-abdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract.
IEEE transactions on bio-medical engineering 10/2014; 62(3). DOI:10.1109/TBME.2014.2366032 · 2.35 Impact Factor
Available from: PubMed Central
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ABSTRACT: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting.
Clinical and Experimental Gastroenterology 06/2013; 6(1):91-9. DOI:10.2147/CEG.S34435
Gastrointestinal endoscopy 05/2015; 82(2). DOI:10.1016/j.gie.2014.11.007 · 5.37 Impact Factor
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