A modular magnetic anastomotic device for minimally invasive digestive anastomosis: proof of concept and preliminary data in the pig model

Abstract

Background The aim of our study was to assess the feasibility of minimally invasive digestive anastomosis using a modular flexible magnetic anastomotic device made up of a set of two flexible chains of magnetic elements. The assembly possesses a non-deployed linear configuration which allows it to be introduced through a dedicated small-sized applicator into the bowel where it takes the deployed form. A centering suture allows the mating between the two parts to be controlled in order to include the viscerotomy between the two magnetic rings and the connected viscera. Methods and procedures Eight pigs were involved in a 2-week survival experimental study. In five colorectal anastomoses, the proximal device was inserted by a percutaneous endoscopic technique, and the colon was divided below the magnet. The distal magnet was delivered transanally to connect with the proximal magnet. In three jejunojejunostomies, the first magnetic chain was injected in its linear configuration through a small enterotomy. Once delivered, the device self-assembled into a ring shape. A second magnet was injected more distally through the same port. The centering sutures were tied together extracorporeally and, using a knot pusher, magnets were connected. Ex vivo strain testing to determine the compression force delivered by the magnetic device, burst pressure of the anastomosis, and histology were performed. Results Mean operative time including endoscopy was 69.2 ± 21.9 min, and average time to full patency was 5 days for colorectal anastomosis. Operative times for jejunojejunostomies were 125, 80, and 35 min, respectively. The postoperative period was uneventful. Burst pressure of all anastomoses was C110 mmHg. Mean strain force to detach the devices was 6.1 ± 0.98 and 12.88 ± 1.34 N in colorectal and jejunojejunal connections, respectively. Pathology showed a mild-to-moderate inflammation score. Conclusions The modular magnetic system showed enormous potential to create minimally invasive digestive anastomoses, and may represent an alternative to stapled anastomoses, being easy to deliver, effective, and low cost.

Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis

“…Compression induces an ischemia-necrosis-scarring cycle, which creates a patent connection in approximately 5 to 10 days. 20,21 This gradual process induces healing with a lower inflammatory reaction when compared to stapled anastomoses. 22 The model of magnetic loop anastomosis used in this study was easy to perform.…”

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model

“…Our results are similar to those reported in the literature. 19,[21][22][23][24] Hand-sewn and stapled anastomoses represent the goldstandard procedures for performing bowel anastomosis. To date, different types of compression anastomosis devices include the Biofragmentable Anastomosis Ring (BAR), the AKA-2, the Compression Anastomosis Clip (CAC), and the EndoCAR (Endo Compression Anastomosis Ring).…”

Experimental Evaluation of the Optimal Suture Pattern With a Flexible Endoscopic Suturing System

“…Variables recorded were (1) suturing time, defined as the time occurred from the OverStitch insertion into the model until the achievement of an airproof suturing; (2) the number of sutures used; and (3) the burst pressure of the suturing line, measured as previously described. 10 Briefly, the explants were filled with water mixed with methylene blue and a needle, connected to an invasive arterial pressure monitoring system (Aisys, GE Healthcare, Wauwatosa, WI), was inserted in the explants. Intraluminal pressure was slowly elevated by fluid injection and by applying external pressure.…”