Kobayashi Toshiaki, Gotohda Takushi, Tamakawa Katsunori, Ueda Hirohisa, Kakizoe Tadao
Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 1-1 Tsukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan.
Jpn J Clin Oncol. 2004 Mar;34(3):118-23. doi: 10.1093/jjco/hyh025.
Technical difficulties are involved in endoscopic mucosal resection (EMR) of gastric cancer since it is a "one handed surgery". These difficulties prevent this technique from being indicated for larger lesions, even when it can possibly be performed for patients with such lesions. If microforceps could assist EMR, this procedure would become easier and safer. Since magnetic force can control objects without direct contact, it can be applied to control microforceps internally in assistance with EMR.
We developed a magnetic anchor consisting of three parts: a magnetic weight with dimensions of 1.0 x 1.0 x 1.5 cm, microforceps and a connecting thread. Endoscopic clips used in hemostasis were used as the microforceps of the magnetic anchor in this study. The magnetic control system consisted of a 0.68 kOe/10 cm/100 A electromagnet, 350 mm in diameter and a circumventing positional frame. The microforceps were inserted into a sheath within the endoscope, and the magnetic weight was secured to the tip of the sheath protruding from the endoscope. The magnetic anchor, along with the endoscope, was inserted through an overtube into the gastric cavity of a swine under general anesthesia. The magnetic anchor was used in a manner similar to that in standard surgery, and EMR was thereby performed.
The mucosa to be resected was satisfactorily dragged and stabilized. The magnetic anchor facilitated EMR, regardless of the technical skills of the endoscopist and region of the stomach at which the technique was performed.
The magnetic anchor is considered to have alleviated some technical problems involved in EMR. It has the potential for making EMR a safer and quicker procedure for the treatment of early gastric cancer, when appropriately indicated.
由于内镜下黏膜切除术（EMR）是一种“单手操作手术”，因此在胃癌的EMR中存在技术难题。这些难题使得该技术不适用于较大的病变，即使对于可能患有此类病变的患者也无法进行。如果微型钳能够辅助EMR，那么该手术将变得更加容易和安全。由于磁力可以在不直接接触的情况下控制物体，因此可以应用于在EMR辅助下内部控制微型钳。
我们开发了一种磁性锚，它由三个部分组成：一个尺寸为1.0×1.0×1.5厘米的磁块、微型钳和一根连接线。本研究中，用于止血的内镜夹被用作磁性锚的微型钳。磁控系统由一个直径350毫米、磁场强度为0.68 kOe/10厘米/100 A的电磁铁和一个环绕定位框架组成。微型钳插入内镜内的护套中，磁块固定在从内镜伸出的护套尖端。在全身麻醉下，将磁性锚与内镜一起通过外套管插入猪的胃腔。以与标准手术类似的方式使用磁性锚，从而进行EMR。
待切除的黏膜被满意地牵拉并稳定住。无论内镜医师的技术水平如何以及手术在胃的哪个区域进行，磁性锚都有助于EMR。
磁性锚被认为减轻了EMR中涉及的一些技术问题。在适当的情况下，它有可能使EMR成为治疗早期胃癌更安全、更快的手术。
