IHU-Strasbourg, Institute of Hybrid Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France.
Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
Surg Endosc. 2020 Mar;34(3):1393-1400. doi: 10.1007/s00464-019-06963-z. Epub 2019 Jul 17.
Laparoscopic gastrojejunostomies are time consuming and require a specific training. Alternatively, sutureless anastomosis can be achieved using endoscopically delivered magnetic rings. Our aim was to assess the feasibility and reproducibility of an endo-laparoscopic gastrojejunostomy technique, using a pair of magnets coated with a near-infrared fluorescent biocompatible polymeric material.
Five pigs (3 acute and 2 survival models) and one human anatomical specimen were included. In the survival models, the distal ring was inserted into the duodenum endoscopically, and it was fixed to a thread clipped to the gastric mucosa. Twenty-four hours later, a two-port laparoscopy was performed using a near-infrared (NIR) laparoscope. The magnet position in the jejunum was detected with the transluminal fluorescence of the dye. Magnetic interaction with the metallic tip of the laparoscopic grasper allowed to capture the ring and bring the bowel loop to the future anastomotic site on the gastric wall. The proximal magnet was inserted into the stomach endoscopically and released when magnetic interaction started, allowing for a precise connection with the distal ring. The animals were followed up for 12 days and underwent control endoscopies and radiograms. In the acute animals, the anastomotic procedure was repeated 24 times. Finally, the procedure was performed in the human anatomical specimen.
There were no technical problems, and magnetic connection could be precisely directed at both the anterior and posterior gastric walls. No complications occurred during the survival period and the anastomoses were patent on day 5. Transluminal fluorescence enabled a rapid detection of the magnet.
Hybrid-reduced port magnetic gastrojejunostomy using a pair of fluorescently coated magnetic rings was feasible, reproducible, and easy to perform in both porcine and cadaver models.
腹腔镜胃空肠吻合术耗时且需要特定的培训。或者，可以使用内镜输送的磁性环进行无缝合吻合。我们的目的是评估使用一对涂有近红外荧光生物相容聚合物材料的磁性环进行内镜腹腔镜胃空肠吻合术的可行性和可重复性。
纳入了 5 头猪（3 头急性和 2 头存活模型）和 1 个人体解剖标本。在存活模型中，远端环经内镜插入十二指肠，并通过夹在胃黏膜上的线固定。24 小时后，使用近红外（NIR）腹腔镜进行两孔腹腔镜检查。通过染料的腔内荧光检测到磁环在空肠中的位置。磁性与腹腔镜抓钳的金属尖端的相互作用允许捕获环并将肠环带到胃壁上的未来吻合部位。近端磁体经内镜插入胃中，并在磁性相互作用开始时释放，以便与远端磁环精确连接。动物被随访 12 天，并进行了对照内镜检查和放射检查。在急性动物中，吻合程序重复了 24 次。最后，在人体解剖标本中进行了该程序。
没有技术问题，并且可以精确地将磁性连接到胃的前壁和后壁。在存活期间没有发生并发症，并且吻合在第 5 天是通畅的。腔内荧光能够快速检测到磁体。
使用一对荧光涂层的磁性环进行混合-减少端口磁性胃空肠吻合术在猪和尸体模型中都是可行的、可重复的且易于操作。
