Ryou M, Thompson C C
Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Endoscopy. 2009 Feb;41(2):143-8. doi: 10.1055/s-0028-1119454. Epub 2009 Feb 12.
Because of their reliance on the flexible endoscope, most current procedures in natural-orifice transluminal endoscopic surgery (NOTES) suffer from the inability to vigorously grasp and move tissue or to retract organs. We aimed to assess the use of internal and external magnets that might allow the vigorous multiaxial traction/countertraction required in more complicated NOTES procedures.
Ex vivo and in vivo porcine model. Study components were: (1) Evaluation of force-distance relationship of this magnetic retraction system using a digital tensiometer. (2) Application of this magnetic retraction system to two procedures in the porcine model: (a) Liver retraction during transcolonic cholecystectomy in five nonsurvival pigs. Procedure time was recorded and compared to historical controls. (b) Mesh positioning for implantation into the anterior abdominal wall for ventral hernia repair in three survival pigs.
Over a distance of 5 cm to 0.25 cm, the magnetic force of our system increased from 3 to 90 gramforce (29.42 to 882.60 mN.) In vivo, the magnet system provided robust liver retraction, shortening the procedure time of NOTES cholecystectomy from a historical mean of 68 minutes (range 42 - 90 minutes; n = 5) to 49.6 minutes (range 33 - 61 minutes; n = 3). The magnetic system also greatly enhanced mesh positioning and stability, and these animals survived for 2 weeks without complications.
Our basic system provided critical liver retraction during NOTES cholecystectomy and was also instrumental in moving and stabilizing mesh for implantation during NOTES ventral hernia repair. Magnets can potentially provide the vigorous traction and countertraction required to advance NOTES procedures.
由于目前大多数经自然腔道内镜手术（NOTES）依赖于可弯曲内镜，因而无法有力地抓取和移动组织或牵拉器官。我们旨在评估使用内部和外部磁体的情况，这可能会在更复杂的NOTES手术中提供所需的有力多轴牵引/反牵引。
采用离体和活体猪模型。研究内容包括：（1）使用数字张力计评估该磁体牵拉系统的力-距离关系。（2）将该磁体牵拉系统应用于猪模型的两项手术：（a）五只非存活猪经结肠胆囊切除术中的肝脏牵拉。记录手术时间并与历史对照进行比较。（b）三只存活猪腹前壁植入补片修复腹疝时的补片定位。
在5厘米至0.25厘米的距离内，我们系统的磁力从3克力增加到90克力（29.42至882.60毫牛）。在活体中，磁体系统提供了有力的肝脏牵拉，将NOTES胆囊切除术的手术时间从历史平均68分钟（范围42 - 90分钟；n = 5）缩短至49.6分钟（范围33 - 61分钟；n = 3）。磁体系统还极大地增强了补片的定位和稳定性，这些猪存活了2周且无并发症。
我们的基础系统在NOTES胆囊切除术中提供了关键的肝脏牵拉，并且在NOTES腹疝修补术中移动和稳定植入补片方面也发挥了作用。磁体有可能提供推进NOTES手术所需的有力牵引和反牵引。
