Mohamed Mortagy, Department of Internal Medicine, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI 49008, United States.
World J Gastroenterol. 2017 Apr 28;23(16):2883-2890. doi: 10.3748/wjg.v23.i16.2883.
Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.
内镜黏膜下剥离术（ESD）是一种成熟的、微创的治疗胃肠道浅表肿瘤的方法。由于其学习曲线缓慢、手术时间长、并发症风险高，ESD 的广泛应用受到了限制。其中一个技术挑战是缺乏类似于传统手术中的第二只手来提供牵引力。可靠的组织牵拉可以暴露黏膜下剥离平面，从而实现更安全、更高效的剥离。与其他当前的牵引方法相比，磁锚引导内镜黏膜下剥离术（MAG-ESD）具有潜在的优势。MAG-ESD 提供了一种独立于内镜的组织牵拉方式，模拟了外科医生的“第二只手”。可以使用两种类型的磁铁：电磁体和永磁体。本文综述了 MAG-ESD 技术、已发表的相关研究以及 ESD 中磁铁的应用。我们还回顾了磁锚引导系统在经自然腔道内镜手术中的应用，以及利用表面铁磁化实现的非接触式磁牵引的设想。我们讨论了当前的局限性、MAG-ESD 的未来潜力以及采用这项技术所需的发展。
