An Original Endoluminal Magnetic Anastomotic Device Allowing Pure NOTES Transgastric and Transrectal Sigmoidectomy in a Porcine Model

IRCAD/EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
Surgical Innovation (Impact Factor: 1.46). 12/2011; 19(2):109-16. DOI: 10.1177/1553350611429029
Source: PubMed


While experimental natural orifice transluminal endoscopic surgery (NOTES) sigmoid colectomies have been reported, pure NOTES anastomoses are restricted by the limited reach of commercially available circular staplers. MAGNAMOSIS is a set of self-orienting magnetic rings that can be delivered endoluminally throughout the colon to generate a compression anastomosis. Aim. To assess the feasibility of a pure NOTES transrectal (TR) and transgastric (TG) approach to perform any segmental colectomy.
One pig (50 kg) underwent the experimental procedure as follows: (a) creation of the TG access to the peritoneal cavity, (b) precise transluminal placement of the proximal MAGNAMOSIS ring, (c) creation of the TR access with the TEO and transrectal dissection of the sigmoid mesentery, (d) resection of the surgical specimen, (e) transrectal extraction of the specimen, (f) delivery and mating of the distal MAGNAMOSIS ring, and (g) closure of the TG and TR viscerotomies. The animal survived for 14 days at which time burst pressure and histology were performed.
A pure NOTES TR and TG segmental colectomy was performed in 139 minutes. The postoperative course was uneventful. The animal had a formed bowel movement including the magnetic rings on postoperative day 5. Endoscopic examination at postoperative day 14 revealed a patent anastomosis. Necropsy revealed no abscess or signs of peritonitis. Burst pressure was >198 mm Hg. The histology showed a sealed anastomosis with mild inflammation.
MAGNAMOSIS enabled a totally NOTES partial colectomy with combined TG and TR access. The flexible delivery options and low cost of manufacturing could make MAGNAMOSIS an attractive alternative to circular staplers.

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    ABSTRACT: Background: The beneficial clinical results of laparoscopic surgery have prompted modern investigations to further minimize surgical trauma and to optimize cosmetic results. Natural orifice transluminal endoscopic surgery (NOTES®) refers to the surgical concept of entering the surgical field through a body lumen for diagnostic and therapeutic purposes without producing visible scars. Method: A review of the current literature was undertaken by means of the electronic databases Excerpta Medica and EMBASE. Results: Although the level of clinical evidence is low, the concept of NOTES has found clinical application in a variety of abdominal procedures, such as cholecystectomy, appendectomy, and sigmoidectomy. The vagina represents the most frequent access route for NOTES while the stomach, the rectum, and the transoral approach are further options. Several clinical studies have demonstrated the feasibility of a wide variety of NOTES procedures; however, there are currently no hard data supporting the superiority of this approach over conventional laparoscopic techniques. Furthermore, inherent limitations of the NOTES concept, such as the loss of triangulation, difficult tissue manipulation, and the potential contamination of the surgical field, warrant technological advances in medical endoscopy, instrumentation, and endoscopic tissue closure. Conclusions: In its current status, NOTES has to be considered as a stage towards minimization of surgical access trauma rather than as an established surgical concept.
    No preview · Article · Dec 2012 · Viszeralmedizin / Visceral Medicine
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    No preview · Article · Apr 2013 · Surgical Innovation
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    ABSTRACT: Background and study aims: MAGNAMOSIS forms a compression anastomosis using self-assembling magnetic rings that can be delivered via flexible endoscopy. The system has proven to be effective in full-thickness porcine small-bowel anastomoses. The aim of this study was to show the feasibility of the MAGNAMOSIS system in hybrid endoscopic colorectal surgery and to compare magnetic and conventional stapled anastomoses. Methods: A total of 16 swine weighing 35 - 50 kg were used following animal ethical committee approval. The first animal was an acute model to establish the feasibility of the procedure. The subsequent 15 animals were survival models, 10 of which underwent side-to-side anastomoses (SSA) and 5 of which underwent end-to-side (ESA) procedures. Time to patency, surveillance endoscopy, burst pressure, compression force, and histology were assessed. Histology was compared with conventional stapled anastomoses. Magnetic compression forces were measured in various anastomosis configurations. Results: Colorectal anastomoses were performed in all cases using a hybrid NOTES technique. The mean operating time was 71 minutes. Mean time to completion of the anastomosis was similar between the SSA and ESA groups. Burst pressure at 10 days was greater than 95 mmHg in both groups. One complication occurred in the ESA group. Compression force among various configurations of the magnetic rings was significantly different (P < 0.05). Inflammation and fibrosis were similar between magnetic SSA and conventional stapled anastomoses. Conclusion: MAGNAMOSIS was feasible in performing a hybrid NOTES colorectal anastomosis. It has the advantage over circular staplers of precise endoscopic delivery throughout the entire colon. SSA was reliable and effective. A minimum initial compression force of 4 N appears to be required for reliable magnetic anastomoses.
    No preview · Article · Jun 2013 · Endoscopy
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