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Zhang G, Liang Z, Zhao G, Zhang S. Endoscopic application of magnetic compression anastomosis: a review. J Gastroenterol Hepatol 2024; 39:1256-1266. [PMID: 38638082 DOI: 10.1111/jgh.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Magnetic compression anastomosis (MCA) is a new method that provides sutureless passage construction for tubular organs. Due to the high recurrence rate of conventional endoscopic treatment and the high morbidity and mortality of surgical procedures, the MCA technique shows promise. The aim of this review is to comprehensively examine the literature related to the use of MCA in different gastrointestinal diseases over the past few years, categorizing them according to the anastomotic site and describing in detail the various methods of magnet delivery and the clinical outcomes of MCA. MCA is an innovative technique, and its use represents an advancement in the field of minimally invasive interventions. Comparison studies have shown that the anastomosis formed by MCA is comparable to or better than surgical sutures in terms of general appearance and histology. Although most of the current research has involved animal studies or studies with small populations, the safety and feasibility of MCA have been preliminarily demonstrated. Large prospective studies involving populations are still needed to guarantee the security of MCA. For technologies that have been initially used in clinical settings, effective measures should also be implemented to identify, even prevent, complications. Furthermore, specific commercial magnets must be created and optimized in this emerging area.
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Affiliation(s)
- Guo Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Liang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Gagner M, Abuladze D, Koiava L, Buchwald JN, Van Sante N, Krinke T. First-in-Human Side-to-Side Magnetic Compression Duodeno-ileostomy with the Magnet Anastomosis System. Obes Surg 2023; 33:2282-2292. [PMID: 37393568 PMCID: PMC10345004 DOI: 10.1007/s11695-023-06708-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
PURPOSES Classical gastrointestinal anastomoses are formed with sutures and/or metal staples, resulting in significant bleeding and leak rates. This study evaluated the feasibility and safety of the novel magnet anastomosis system (MS) to create a side-to-side duodeno-ileal (DI) diversion for weight loss and type 2 diabetes (T2D) resolution. MATERIALS AND METHODS Patients with severe obesity (body mass index (BMI) ≥ 35 kg/m2 with/without T2D (HbA1C ≥ 6.5%)) underwent the study procedure, a side-to-side MS DI diversion, with a standard sleeve gastrectomy (SG). A linear magnet was delivered by flexible endoscopy to a point 250 cm proximal to the ileocecal valve; a second magnet was positioned in the first part of the duodenum; the bowel segments containing magnets were apposed, initiating gradual anastomosis formation. Laparoscopic assistance was used to obtain bowel measurements, obviate tissue interposition, and close mesenteric defects. RESULTS Between November 22 and 26, 2021, 5 female patients (mean weight 117.6 ± 7.1 kg, BMI (kg/m2) 44.4 ± 2.2) underwent side-to-side MS DI + SG. All magnets were successfully placed, expelled without re-intervention, and formed patent durable anastomoses. Total weight loss at 12 months was 34.0 ± 1.4% (SEM); excess weight loss, 80.2 ± 6.6%; and BMI reduction, 15.1. Mean HbA1C (%) dropped from 6.8 ± 0.8 to 4.8 ± 0.2; and glucose (mg/dL), from 134.3 ± 17.9 to 87.3 ± 6.3 (mean reduction, 47.0 mg/dL). There was no anastomotic bleeding, leakage, obstruction, or infection and no mortality. CONCLUSIONS Creation of a side-to-side magnetic compression anastomosis to achieve duodeno-ileostomy diversion in adults with severe obesity was feasible and safe, achieved excellent weight loss, and resolved type 2 diabetes at 1-year follow-up. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05322122.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada.
| | - David Abuladze
- Department of General & Bariatric Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
| | - Levan Koiava
- Department of General & Bariatric Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
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Vilhjalmsson D, Lepsenyi M, Syk I, Grönberg A, Thorlacius H. Transanal formation of anastomosis using C-REX device is feasible and effective in high anterior resection. Int J Colorectal Dis 2023; 38:127. [PMID: 37173554 PMCID: PMC10182144 DOI: 10.1007/s00384-023-04420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE C-REX is a novel instrument for creating stapleless colorectal anastomosis by compression. The aim of this study was to evaluate the feasibility and effectiveness of C-REX in open and laparoscopic high anterior resections. METHODS A prospective clinical safety study on 21 patients reconstructed with C-REX colorectal anastomosis following high anterior resection of the sigmoid colon using two different devices for intraabdominal (n = 6) or transanal (n = 15) placement of the anastomotic rings. Any signs of complications were prospectively monitored by a predefined protocol. Anastomotic contact pressure (ACP) was measured via a catheter-based system, and time for evacuation of the anastomotic rings by the natural route was noted. Blood samples were collected daily, and flexible endoscopy was performed postoperatively to examine macroscopic appearance of the anastomoses. RESULTS One of six patients operated with the intraabdominal anastomosis technique with an ACP of 50 mBar had to be reoperated because of anastomotic leakage. None of the 15 patients operated with the transanal technique (5 open and 10 laparoscopic procedures) had anastomotic complications, and their ACP ranged between 145 and 300 mBar. C-REX rings were uneventfully expelled by the natural route in all patients after a median of 10 days. Flexible endoscopy showed well-healed anastomoses without stenosis in 17 patients and a moderate subclinical stricture in one patient. CONCLUSION These results indicate that the novel transanal C-REX device is a feasible and effective method for colorectal anastomosis following high anterior resections, irrespective of open or laparoscopic approach. Moreover, C-REX allows measurement of intraoperative ACP and thereby a quantitative evaluation of the anastomotic integrity.
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Affiliation(s)
- Dadi Vilhjalmsson
- Department of Clinical Sciences, Section of Surgery, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Mattias Lepsenyi
- Department of Clinical Sciences, Section of Surgery, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Ingvar Syk
- Department of Clinical Sciences, Section of Surgery, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Anders Grönberg
- Section of Development, CarpoNovum, Halmstad, 302 41, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery, Malmö, Lund University, Malmö, 205 02, Sweden.
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Gagner M, Krinke T, Lapointe-Gagner M, Buchwald JN. Side-to-side duodeno-ileal magnetic compression anastomosis: design and feasibility of a novel device in a porcine model. Surg Endosc 2023:10.1007/s00464-023-10105-x. [PMID: 37170025 DOI: 10.1007/s00464-023-10105-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Minimally invasive metabolic/bariatric surgery (MBS) may be further advanced by magnetic compression anastomosis (MCA) technology. The study aimed to develop a magnet sized to create a patent duodeno-ileostomy (DI) and verify its effectiveness in a porcine model. METHODS Developmental study phase: magnets with 4 different flange-offset dimensions were tested to identify a design that would successfully form a compression anastomosis. Verification phase: evaluation of the selected design's efficacy. In each 6-week phase (4 pigs/phase), one magnet was inserted laparoscopically in the jejunum, one placed gastroscopically in the duodenum. Magnets were aligned, gradually fused, formed an anastomosis, and then detached and were expelled. At necropsy, MCA sites and sutured enterotomy sites were collected and compared. RESULTS Developmental phase: the linear BC42 magnet with a 2.3-mm flange offset design was selected. Verification phase: in 4 swine magnets were mated at the target location, confirmed radiographically. Mean time to magnet detachment 16.0 days (12-22), to expulsion 24.5 days (17-33). MCA was achieved in all animals at time of sacrifice. Animals gained a mean 9.5 kg (3.9-11.8). Specimens revealed patent anastomoses of ≥ 20 mm with smooth mucosa and minimal inflammation and fibrosis compared to sutured enterotomies. One pig underwent corrective surgery for a mesenteric hernia without sequelae. CONCLUSION In a large-animal model, gross and histopathologic examination confirmed that the linear MCA device created a patent, well-vascularized, duodeno-ileal anastomosis. The novel MCA device may be appropriate for use in human MBS procedures.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada.
| | | | - Maxime Lapointe-Gagner
- Department of Surgery, Westmount Square Surgical Center, 1 Westmount Square, Suite 801, Westmount, QC, H3Z2P9, Canada
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
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Comparative early histologic healing quality of magnetic versus stapled small bowel anastomosis. Surgery 2023; 173:1060-1065. [PMID: 36566103 DOI: 10.1016/j.surg.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Successful anastomotic healing is critical to preventing complications after intestinal surgery. We aimed to compare the early healing of end-to-end small bowel anastomosis by self-forming magnets with surgical stapling in a porcine model. METHOD Six Yorkshire pigs underwent 2 simultaneous small bowel anastomoses using a circular stapler and self-forming magnet technique. The primary outcome was healing quality, measured by 4 histologic features: inflammatory cell infiltration, collagen formation, grade of inflammation, and bacterial infiltration at the anastomosis. The samples were evaluated at days 1, 3, and 7. Gross evaluation of anastomotic integrity was a secondary outcome. RESULTS The self-forming magnet group displayed significant differences at each time point. On day 1, the stapled group displayed dense inflammatory cell infiltration and extensively ulcerated intestinal layers with significant edema. The self-forming magnet group showed less inflammatory infiltrate, and all intestinal layers remained compressed in direct apposition. By day 3, the self-forming magnet group already exhibited neovascularization with scant bacterial colonies. By contrast, stapled anastomoses had large areas of inflammation separating collagen fibers with prevalent bacterial infiltrations. On day 7, self-forming magnet anastomoses were characterized by robust neovascularization, maturing granulation tissue, and mucosal re-epithelization without significant inflammation. Meanwhile, stapled samples had persisting dense inflammation, tissue cavities with hemorrhage, and immature fibrous tissue. Grossly, the self-forming magnet created a patent lumen without defect, whereas stapled anastomoses demonstrated focal areas of serosal separation. CONCLUSION Bowel anastomosis by self-forming magnets is associated with superior early histologic healing metrics, including early seal generation through mechanical compression, decreased inflammation, early neovascularization, lower bacterial infiltration, and faster re-epithelization.
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Kim J, Park S, Kim N, Lee IY, Jung HS, Ahn H, Son GM, Baek K. Compression automation of circular stapler for preventing compression injury on gastrointestinal anastomosis. Int J Med Robot 2022; 18:e2374. [PMID: 35106896 PMCID: PMC9285555 DOI: 10.1002/rcs.2374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
Abstract
Background Conventional manual compression relies on the surgeon's subjective sensations, so excessive compression can cause tissue injury to the stapling line of the intestinal anastomosis. Methods Automatic compression monitoring and compression control system was developed for circular stapler. The tissue injury related compression variables were evaluated and accommodated by compression control device. The compression injury‐reducing performance was verified on collagen sheets of in vitro experiments. Results Excessive pressure and tissue deformation were associated with compression‐induced tissue damages. The safe pressure range was very narrow in weaker tissue than normal collagen. The automatic system performed proper compression within a safe pressure range without tissue injury. Conclusions Manual compression of circular stapler could cause tissue injuries by excessive pressure and tissue deformation. Our automatic compression system is designed to control peak pressure to prevent the compressive tissue injury.
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Affiliation(s)
- Jin‐Seok Kim
- School of Electronics Engineering Pusan National University Busan Korea
| | - Sang‐Ho Park
- School of Electronics Engineering Pusan National University Busan Korea
| | - Nam‐Su Kim
- School of Electronics Engineering Pusan National University Busan Korea
| | - In Young Lee
- Department of Surgery Medical Research Institute Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan Korea
| | - Hyun Seok Jung
- Department of Surgery Medical Research Institute Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan Korea
| | - Hong‐Min Ahn
- Department of Surgery Medical Research Institute Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan Korea
| | - Gyung Mo Son
- Department of Surgery Medical Research Institute Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan Korea
| | - Kwang‐Ryul Baek
- School of Electronics Engineering Pusan National University Busan Korea
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Steger J, Jell A, Ficht S, Ostler D, Eblenkamp M, Mela P, Wilhelm D. Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques. Ther Clin Risk Manag 2022; 18:523-539. [PMID: 35548666 PMCID: PMC9081039 DOI: 10.2147/tcrm.s335102] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery. Methods A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK). Results All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques' current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions. Conclusion Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons' levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body's natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.
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Affiliation(s)
- Jana Steger
- Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany
| | - Alissa Jell
- Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Clinic and Polyclinic for Surgery, Munich, Germany
| | - Stefanie Ficht
- Technical University of Munich, TUM School of Engineering and Design, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, Garching, Germany
| | - Daniel Ostler
- Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany
| | - Markus Eblenkamp
- Technical University of Munich, TUM School of Engineering and Design, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, Garching, Germany
| | - Petra Mela
- Technical University of Munich, TUM School of Engineering and Design, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, Garching, Germany
| | - Dirk Wilhelm
- Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Clinic and Polyclinic for Surgery, Munich, Germany
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Schlottmann F, Ryou M, Lautz D, Thompson CC, Buxhoeveden R. Sutureless Duodeno-Ileal Anastomosis with Self-Assembling Magnets: Safety and Feasibility of a Novel Metabolic Procedure. Obes Surg 2021; 31:4195-4202. [PMID: 34181211 DOI: 10.1007/s11695-021-05554-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Less invasive and safer anastomotic techniques are desirable. We aimed to determine technical feasibility and safety of sutureless duodeno-ileal side-to-side anastomosis in obese patients using self-assembling magnets. METHODS This was an open-label, prospective, and single-arm study including obese patients (BMI 30-50 kg/m2) with type II diabetes. The ileal magnet was deployed laparoscopically, and the duodenal magnet was deployed endoscopically. Both magnets were coupled under laparoscopic and fluoroscopic guidance. The primary endpoints were technical feasibility and safety. The secondary endpoints were patency of the anastomosis, HbA1c reduction, and weight loss 12 months after the procedure. RESULTS A total of 8 patients were enrolled in the study; median age was 51.5 years (range: 34-65), and median BMI was 38.8 kg/m2 (range: 35-47.9). The mean procedural duration was 63.5 min (range: 41-95). No intraoperative complications were recorded, and no major postoperative morbidity related to the procedure occurred. Magnets were expelled at a median of 29.5 days after the procedure with no associated complications. Upper endoscopy at 12 months confirmed patent anastomoses with healthy-appearing mucosa in all patients. HbA1c reduced below 7.0% in 6 out of 8 (75%) patients, and greater than 5% of total body weight loss was observed in 7 out of 8 (87.5%) patients at 12 months. CONCLUSIONS Sutureless duodeno-ileal side-to-side anastomosis using self-assembling magnets is feasible and safe in obese patients, and a dual-path enteral diversion with large-caliber and durable anastomosis can be achieved.
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Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina.
| | - Marvin Ryou
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Rudolf Buxhoeveden
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
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Kang SI. Effort to Improve Rectal Anastomosis: the Triple-Stapled Technique for Rectal Anastomosis. Ann Coloproctol 2021; 37:1-2. [PMID: 33730794 PMCID: PMC7989562 DOI: 10.3393/ac.2021.02.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Sung Il Kang
- Division of Colorectal Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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Advances and Trends in Pediatric Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9123999. [PMID: 33321836 PMCID: PMC7764454 DOI: 10.3390/jcm9123999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.
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Reischl S, Wilhelm D, Friess H, Neumann PA. Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects. Langenbecks Arch Surg 2020; 406:971-980. [PMID: 32803330 PMCID: PMC8208906 DOI: 10.1007/s00423-020-01957-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE In most cases, traditional techniques to perform an anastomosis following gastrointestinal resections lead to successful healing. However, despite focused research in the field, in certain high-risk situations leakage rates remain almost unchanged. Here, additional techniques may help the surgeon to protect the anastomosis and prevent leakage. We give an overview of some of the latest developments on experimental and clinical techniques for induction of anastomotic healing. METHODS We performed a review of the current literature on approaches to improve anastomotic healing. RESULTS Many promising approaches with a high clinical potential are in the developmental pipeline. Highly experimental approaches like inhibition of matrix metalloproteinases, stem cell therapy, hyperbaric oxygen therapy, induction of the hypoxic adaptive response, and the administration of growth factors are still in the preclinical phase. Other more clinical developments aim to strengthen the anastomotic suture line mechanically while shielding it from the influence of the microbiome. Among them are gluing, seaming the staple line, attachment of laminar biomaterials, and temporary intraluminal tubes. In addition, individualized bowel preparation, selectively reducing certain detrimental microbial populations could become the next stage of bowel preparation. Compression anastomoses are evolving as an equivalent technique additional to established hand-sewn and stapled anastomoses. Fluorescence angiography and flexible endoscopy could complement intraoperative quality control additionally to the air leak tests. Virtual ileostomy is a concept to prepare the bowel for the easy formation of a stoma in case of leakage. CONCLUSION A variety of promising diagnostic and prophylactic measures that may support the surgeon in identifying high-risk anastomoses and support them according to their potential deficits is currently in development.
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Affiliation(s)
- Stefan Reischl
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Endoscopic Magnetic Compression Anastomosis For Small Bowel Bypass in a High Operative Risk Setting. Surg Laparosc Endosc Percutan Tech 2020; 29:e84-e87. [PMID: 31107851 DOI: 10.1097/sle.0000000000000669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The endoscopic enteroenteral bypass could revolutionize the treatment of small bowel obstruction (SBO) in inoperable patients. We describe the technique of endoscopic delivery of a magnetic compression anastomosis device and the creation of an enteroenteral anastomosis in a patient with recurrent acute on chronic SBOs and prohibitively high operative risk. In this novel procedure, a magnetic compression anastomosis device is delivered on either side of the obstruction using a hybrid endoscopic/fluorographic technique, effectively bypassing the obstruction and relieving symptoms. The anastomosis was endoscopically evaluated at regular intervals postprocedure. By 7 days, healthy villi were visible through the mated magnetic rings. By 10 days, the anastomosis was widely patent. The rings passed through the ileostomy and were evacuated, and the patient's symptoms completely resolved. The anastomosis remained widely patent at 1 year. In summary, this case demonstrates the benefit of magnetic compression anastomosis in a patient with SBO and high operative risk.
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Hybrid fluorescent magnetic gastrojejunostomy: an experimental feasibility study in the porcine model and human cadaver. Surg Endosc 2019; 34:1393-1400. [DOI: 10.1007/s00464-019-06963-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
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Diaz R, Davalos G, Welsh LK, Portenier D, Guerron AD. Use of magnets in gastrointestinal surgery. Surg Endosc 2019; 33:1721-1730. [PMID: 30805789 DOI: 10.1007/s00464-019-06718-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic and endoscopic surgery has undergone vast progress during the last 2 decades, translating into improved patient outcomes. A prime example of this development is the use of magnetic devices in gastrointestinal surgery. Magnetic devices have been developed and implemented for both laparoscopic and endoscopic surgery, providing alternatives for retraction, anchoring, and compression among other critical surgical steps. The purpose of this review is to explore the use of magnetic devices in gastrointestinal surgery, and describe different magnetic technologies, current applications, and future directions. METHODS IRB approval and written consent were not required. In this review of the existing literature, we offer a critical examination at the use of magnets for gastrointestinal surgery currently described. We show the experiences done to date, the benefits in laparoscopic and endoscopic surgery, and additional future implications. RESULTS Magnetic devices have been tested in the field of gastrointestinal surgery, both in the contexts of animal and human experimentation. Magnets have been mainly used for retraction, anchoring, mobilization, and anastomosis. CONCLUSION Research into the use of magnets in gastrointestinal surgery offers promising results. The integration of these technologies in minimally invasive surgery provides benefits in various procedures. However, more research is needed to continually evaluate their impact and implementation into surgical practice.
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Affiliation(s)
- Ramon Diaz
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Gerardo Davalos
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Leonard K Welsh
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Dana Portenier
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Alfredo D Guerron
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA.
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Graves CE, Co C, Hsi RS, Kwiat D, Imamura-Ching J, Harrison MR, Stoller ML. Magnetic Compression Anastomosis (Magnamosis): First-In-Human Trial. J Am Coll Surg 2017; 225:676-681.e1. [DOI: 10.1016/j.jamcollsurg.2017.07.1062] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 01/28/2023]
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Vanbrugghe C, Birnbaum DJ, Berdah SV. Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model. Surg Innov 2017; 24:233-239. [PMID: 28492355 DOI: 10.1177/1553350617693125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Compression anastomosis has been recently abandoned because of a nonsuperiority compared to stapling anastomosis. Nonremoval of the rings has frequently been reported and this technique does not support a routine use. The aim of this experimental study was to assess the feasibility of anastomosis using compression with a device consisting of fragmented rings. METHODS A new compression device, the "Anastocom," was compared to standard double-stapled colocolonic anastomosis in 2 groups of 8 pigs. In each group, colocolonic anastomosis was performed with a circular stapler (DST Series EEA Staplers) in 4 pigs and with the Anastocom device for the other 4 pigs. RESULTS The anastomotic rings were expelled between postoperative day 7 and day 13 from the 4 animals sacrificed at day 30. The anastomosis was clean and intact in all pigs. After sacrifice, there was no difference in the bursting pressure at day 7 ( P = .226) or at day 30 ( P = .885) between the 2 types of anastomosis. After sacrifice at day 7, the mean bursting pressure values for the Anastocom and EEA anastomoses were 128.6 mm Hg (range 119-143 mm Hg) and 218.9 mm Hg (range 84-240 mm Hg), respectively. After sacrifice at day 30, the mean bursting pressure values for the Anastocom and EEA anastomoses were 111 mm Hg (range 59-234 mm Hg) and 105 mm Hg (range 81-130 mmHg), respectively. CONCLUSION No bowel obstruction was observed with Anastocom. This fragmentation mechanism should better prevent nonexpulsion compared to basic compression anastomosis.
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Paonessa S, Barbani N, Rocchietti EC, Giachino C, Cristallini C. Design and development of a hybrid bioartificial water-induced shape memory polymeric material as an integral component for the anastomosis of human hollow organs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 75:1427-1434. [PMID: 28415434 DOI: 10.1016/j.msec.2017.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/29/2016] [Accepted: 03/04/2017] [Indexed: 11/28/2022]
Abstract
A large number of pathologies require the resection of the bowel and anastomoses to rejoin the two remaining stumps to regain lumen patency. Various materials have been used to rejoin one bowel end to the other such as catgut, stainless steel, and absorbable sutures. The present method for anastomosis surgery uses an entero-entero anastomosis (EEA) circular stapler with only a staple line. This method can have some drawbacks, such as intracellular fluid leakage and local inflammations. The aim of this study is to design and develop a novel bioartificial polymer with a ring shape made of polyvinyl alcohol (PVA) and gelatin (80/20 ratio (w/w)) loaded both directly with acetylsalicylic acid and with nanoparticles incorporating the same drug to reduce local inflammation even for a prolonged period of time. A physical method (8cycles freezing/thawing) was used to obtain a crosslinked bioartificial shape memory ring. Mechanical analysis showed a storage modulus having a comparable value with that of the human colon. HPLC analysis pointed out a sustained and prolonged release of the anti-inflammatory drug both immediately after anastomosis surgery and during healing period. Cell culture tests indicated the cytocompatibility of the bioartificial device. A shape memory of the hydrogel prepared in ring form was observed at 37°C after immersion in water. These bioartificial devices can represent a new approach to serve as a multifunctional anastomotic ring.
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Affiliation(s)
- Siriana Paonessa
- Department of Civil and Industrial Engineering, University of Pisa, Pisa 56122, Italy
| | - Niccoletta Barbani
- Department of Civil and Industrial Engineering, University of Pisa, Pisa 56122, Italy
| | | | - Claudia Giachino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin 10043, Italy
| | - Caterina Cristallini
- Institute for Chemical and Physical Processes, IPCF, C.N.R., Pisa, 56122, Italy.
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Zhang H, Tan K, Fan C, Du J, Li J, Yang T, Lv Y, Du X. Magnetic compression anastomosis for enteroenterostomy under peritonitis conditions in dogs. J Surg Res 2017; 208:60-67. [DOI: 10.1016/j.jss.2016.08.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
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19
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Tabola R, Cirocchi R, Fingerhut A, Arezzo A, Randolph J, Grassi V, Binda GA, D'Andrea V, Abraha I, Popivanov G, Di Saverio S, Zbar A. A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses. Tech Coloproctol 2017; 21:177-184. [PMID: 28132113 DOI: 10.1007/s10151-017-1583-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.
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Affiliation(s)
- R Tabola
- Department of General and Gastrointestinal Surgery, Medical University of Wrocław, Wrocław, Poland
| | - R Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - A Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - J Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | - V Grassi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - G A Binda
- Colorectal Surgery Unit, Galliera Hospital, Genoa, Italy
| | - V D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - I Abraha
- Department of Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - G Popivanov
- Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
| | - S Di Saverio
- General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health Services, Bologna, Italy
| | - A Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Anatomy, University of Otago, Dunedin, New Zealand
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Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O'Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG. A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 2017; 19:O1-O12. [PMID: 27671222 DOI: 10.1111/codi.13534] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Abstract
The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.
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Affiliation(s)
- A Vallance
- Royal College of Surgeons of England, London, UK
| | - S Wexner
- Cleveland Clinic Florida, Weston, Florida, USA
| | - M Berho
- Cleveland Clinic Florida, Weston, Florida, USA
| | - R Cahill
- University College Dublin, Dublin, Ireland
| | | | - N Haboubi
- University Hospital of South Manchester, Manchester, UK
| | - R J Heald
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - B Moran
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - R W Motson
- The ICENI Centre, Colchester University Hospital, Colchester, UK
| | - R Novell
- The Royal Free Hospital, London, UK
| | | | - F Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T Rockall
- Royal Surrey County Hospital, Guildford, UK
| | | | - A Windsor
- University College Hospital, London, UK
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Compression versus hand-sewn and stapled anastomosis in colorectal surgery: a systematic review and meta-analysis of randomized controlled trials. Tech Coloproctol 2016; 20:667-76. [PMID: 27554096 DOI: 10.1007/s10151-016-1521-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 12/17/2022]
Abstract
Anastomotic leaks are a feared complication of colorectal resections and novel techniques that have the potential to decrease them are still sought. This study aimed to compare the anastomotic leak rates in patients undergoing compression anastomoses versus hand-sewn or stapled anastomoses. Randomized controlled trials (RCTs) comparing outcomes of compression versus conventional (hand-sewn and stapled) colorectal anastomosis were collected from MEDLINE, Embase and the Cochrane Library. The quality of the RCTs and the potential risk of bias were assessed. Pooled odds ratios (OR) were calculated for categorical outcomes and weighted mean differences for continuous data. Ten RCTs were included, comprising 1969 patients (752 sutured, 225 stapled, and 992 compression anastomoses). Most used the biofragmentable anastomotic ring. There was no significant difference between the two groups in terms of anastomotic leak rates (OR 0.80, 95 % confidence interval (CI) 0.47, 1.37; p = 0.42), stricture (OR 0.54: 95 % CI 0.18, 1.64; p = 0.28) or mortality (OR 0.70; 95 % CI 0.39, 1.26; p = 0.24). Compression anastomosis was associated with an earlier return of bowel function: 1.02 (95 % CI 1.37, 0.66) days earlier (p < 0.001) and a shorter postoperative stay; 1.13 (95 % CI 1.52, 0.74) days shorter (p < 0.001), but significant heterogeneity among studies was observed. There was an increased risk of postoperative bowel obstruction in the compression group (OR 1.87; 95 % CI 1.07, 3.26; p = 0.03). There was no significant difference in wound-related and general complications, or length of surgery. Compression devices do not appear to provide an advantage over conventional techniques in fashioning colorectal anastomoses and are associated with an increased risk of bowel obstruction.
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KHOORJESTAN SANAZMOSAFER, ROUHI GHOLAMREZA, TOOLABI KARAMOLLAH. EXPERIMENTAL INVESTIGATIONS ON INTESTINAL ANASTOMOSIS — A COMPARISON BETWEEN AUTOMATIC AND HAND SUTURING TECHNIQUES. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this research, intestinal anastomosis was compared in hand and automatic suturing. This work is based on two different experiments: The first one is the tensile test with the aim of finding the maximum breaking strength with the elongation rate of 5[Formula: see text]mm/min; and the second one is the fatigue test with a frequency of 0.2[Formula: see text]Hz and the amplitude of 16, 24 and 32[Formula: see text]mm of stretch in each phase to discover the total number of cycles to failure. For this purpose, 42 fresh bovine intestines were used; 21 specimens for the tensile and 21 for the fatigue test. These two tests were compared by two hand sewing techniques: simple continuous and ford interlocking stitches, and one automatic technique, i.e., the lock stitches. Seven samples were examined for each particular technique. The results of the tensile test indicated that the breaking strength of automatic sutured specimens is significantly greater than those of hand sutured specimens ([Formula: see text]). That might be due to the regularity, as the suturing lines by machines are more regular than suturing by hand. In addition, results showed that automatic sutured specimens failed in greater number of cycles than hand sutured specimens in the fatigue test ([Formula: see text]).
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Affiliation(s)
| | - GHOLAMREZA ROUHI
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - KARAMOLLAH TOOLABI
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Ma L, Cai XJ, Wang HH, Yu YL, Huang DY, Ge GJ, Hu HY, Yu SC. Laparoscopic colonic anastomosis using a degradable stent in a porcine model. World J Gastroenterol 2016; 22:4707-4715. [PMID: 27217702 PMCID: PMC4870077 DOI: 10.3748/wjg.v22.i19.4707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.
METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group (n = 10) and control group (hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference (AC).
RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group (P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups (P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumference in the control group (P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing.
CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.
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The use of shape memory compression anastomosis clips in cholecystojejunostomy in pigs – a preliminary study. ACTA VET BRNO 2015. [DOI: 10.2754/avb201584040403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper reports on the use of compression anastomosis clips (CAC) in cholecystoenterostomy in an animal model. Cholecystojejunostomy was performed in 6 pigs using implants made of nickel-titanium alloy in the form of elliptical springs with two-way shape memory. The applied procedure led to the achievement of tight anastomosis with a minimal number of complications and positive results of histopathological evaluations of the anastomotic site. The results of the study indicate that shape memory NiTi clips are a promising surgical tool for cholecystoenterostomy in cats and dogs.
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25
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Can a nickel-titanium memory-shape device serve as a substitute for the stapler in gastrointestinal anastomosis? A systematic review and meta-analysis. J Surg Res 2015; 201:82-93. [PMID: 26850188 DOI: 10.1016/j.jss.2015.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/20/2015] [Accepted: 10/08/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently, a nickel-titanium (NiTi) memory-shape device has been successfully used in gastrointestinal anastomosis. The aim of this study was to investigate the feasibility and safety of the device. METHODS Four databases, reference lists, and the World Health Organization International Clinical Trials Registry Platform were systematically searched for randomized controlled trials assessing the clinical efficacy of a NiTi memory-shape device compared with that of a stapler in gastrointestinal or colorectal anastomosis. RESULTS Seven randomized controlled trials regarding the use of compression anastomosis clips (CACs) were enrolled for meta-analysis. The use of CACs was associated with a significant reduction in hospital duration (mean = -0.88 d; 95% confidence interval [CI], -1.38 to -0.38), the time to flatus (mean = -0.36 d; 95% CI, -0.08 to -0.04), and the start of oral intake (mean = -0.45 d; 95% CI, -0.83 to -0.06), as well as a nonsignificant change in postoperative complications and mortality. These clinical outcomes did not significantly change with the use of compression anastomosis rings. CONCLUSIONS Colonic anastomosis with a CAC is likely to reduce hospital duration, time to flatus, and the start of oral intake without influencing mortality or postoperative complications and may be a safe and preferable choice in colonic anastomosis. Further well-designed trials should be performed to determine the safety and efficacy of the newly developed compression anastomosis ring in both ileocolic and colorectal anastomosis.
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Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection. Int J Colorectal Dis 2015; 30:969-75. [PMID: 25989929 DOI: 10.1007/s00384-015-2257-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compression anastomotic ring-locking procedure (CARP) is a novel procedure for creating colonic anastomoses. The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity. We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs, and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans. MATERIALS AND METHODS This is a prospective study on 25 patients undergoing elective left-sided colonic resection. Time for evacuation of the anastomotic rings, perioperative compression pressure, and adverse effects were recorded. Postoperative blood samples were collected daily, and flexible sigmoidoscopy was performed 8-12 weeks after surgery to examine the anastomoses. RESULTS Fourteen out of 25 patients underwent CARP. CARP was not used in 11 patients due to advanced tumor disease (two cases) and size restrictions (nine cases). No case of anastomotic leakage, bowel obstruction, or stenosis formation was observed. No device-related perioperative adverse events were noted. The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days. Perioperative compression pressure ranged between 85 and 280 mBar (median 130 mBar). Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases. CONCLUSION Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.
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27
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Xu ZF, Li ZJ, Sun YL, Zheng Y, Shi HY, Zhen YN, Wang B, Niu HX, Wang RG. A novel spherical magnetic compression device for colorectal anastomosis in a Swine model. J Laparoendosc Adv Surg Tech A 2015; 25:323-9. [PMID: 25853183 DOI: 10.1089/lap.2014.0404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We designed a novel, spherical magnetic compression colorectal anastomosis device and established a swine model to assess the feasibility and safety, as well as advantages, of the device. METHODS AND MATERIALS Fifteen animals were divided into five groups (sacrificed on Days 3, 5 7, 9, and 14) with 3 in each group. In each group, a magnetic compression device was used in 2 animals (experimental animals), and a stapled device was used in 1 animal (control animal). Feeding status, bowel movements, the discharge time of the magnetic anastomosis device, burst pressure, and magnetic field strength were recorded. Gross anatomical and histological examinations were performed. RESULTS The average device discharge time was 7.5 days. The burst pressure increased over time for both the experimental and control animals. Both the gross anatomical and histological examinations suggested that the inflammatory reaction was milder. Healing occurred more quickly, and the incidence of complications was lower for the experimental animals than for the control animals. CONCLUSIONS The potential benefits of the spherical magnetic compression colorectal anastomosis device, relative to the stapled device, were in terms of effectiveness and complication incidence, which encourages us to further study its application in gastrointestinal anastomosis.
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Affiliation(s)
- Zhong-fa Xu
- 1 Department of Colorectal Cancer Surgery, Shandong Cancer Hospital , Jinan, China
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28
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Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27:239-49. [PMID: 24905938 DOI: 10.1111/den.12319] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Abstract
Endoscopic and percutaneous procedures have shown high success rates when used to treat benign biliary stricture. However, cases in which a guidewire cannot be passed through a refractory stricture or a complete obstruction are difficult to treat using conventional methods. Magnetic compression anastomosis (MCA) has emerged as a non-surgical alternative avoiding operational mortality and morbidity. The feasibility and safety of MCA have been experimentally and clinically verified in cases of biliobiliary and bilioenteric anastomosis. However, no pre-MCA assessment modality capable of predicting outcomes is as yet available, and no universally effective magnet delivery method has as yet been established, rendering it difficult to identify patients for whom MCA is appropriate. Various experimental studies seeking to overcome these limitations are underway. Such work will improve our in-depth understanding of MCA, which has been trialed in various fields. Upon further development, MCA may become a ground-breaking option for treatment of benign strictures that are difficult to resolve using conventional methods, and MCA may be expected to be minimally traumatic and highly effective. The aim of the present study was to discuss the current status of MCA and the direction of MCA development by reviewing clinical and experimental MCA data.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Vilhjalmsson D, Olofsson P, Syk I, Thorlacius H, Grönberg A. The compression anastomotic ring-locking procedure: a novel technique for creating a sutureless colonic anastomosis. Eur Surg Res 2014; 54:139-47. [PMID: 25531546 DOI: 10.1159/000368354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Compression anastomoses might represent an improvement over traditional hand-sewn or stapled techniques. Herein, we describe a novel concept of sutureless colonic anastomosis named compression anastomotic ring-locking procedure (CARP). MATERIALS AND METHODS The surgical device consists of two anastomotic rings and their associated helping tools, facilitating the placement of the rings into the intestinal ends. Furthermore, four catheters are connected to the surgical device, allowing the evaluation of the anastomosis during and after surgery. A total of 31 pigs underwent a low colocolic anastomosis using the anastomotic rings. The compression pressure was measured perioperatively and up to 96 h after surgery. Anastomotic integrity and morphology were analyzed by use of radiology and histology, respectively. A long-term follow-up was conducted in a subgroup of pigs up to 108 days after surgery when the bursting pressure and stricture formation were examined. RESULTS All animals recovered uneventfully, and macroscopic examination revealed intact anastomoses without signs of pathological inflammation or adhesions. The perioperative compression pressure was inversely proportional to the gap size between the anastomotic rings. For example, an anastomotic gap of 1.5 mm created a colonic anastomosis with a perioperative compression pressure of 91 mbar, which remained constant for up to 48 h and resulted in a markedly increased compression pressure. Contrast infusion via the catheters effectively visualized the anastomoses, and no leakage was detected within the study. The surgical device was spontaneously evacuated from the intestines within 6 days after surgery. Histology showed collagen bridging of the anastomoses already 72 h after surgery. Long-term follow-up (54-108 days) revealed no stricture formation in the anastomoses, and the bursting pressure ranged from 120 to 235 mbar. The majority of bursts (10/12) occurred distant from the anastomoses. CONCLUSION We conclude that the surgical device associated to CARP is safe and efficient for creating colonic anastomoses. Further studies in patients undergoing colorectal surgery are warranted.
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Affiliation(s)
- Dadi Vilhjalmsson
- Section of Surgery, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Zaritzky M, Ben R, Johnston K. Magnetic gastrointestinal anastomosis in pediatric patients. J Pediatr Surg 2014; 49:1131-7. [PMID: 24952802 DOI: 10.1016/j.jpedsurg.2013.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/29/2013] [Accepted: 11/02/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE To describe 17 patients who underwent magnetic, non-surgical gastrointestinal (GI) anastomoses. METHODS Patients with GI obstruction, stenosis, or atresia were treated with image-guided and/or endoscopically placed discoid magnet pairs or catheter-based bullet-shaped magnet pairs. RESULTS Anastomosis was achieved in 7 days in an 11-year-old with gastric outlet obstruction due to metastatic colon cancer. Anastomosis was achieved in 8 and 10 days in 2 patients (age 2.0 years and 3.4 years) who had rectocolonic stenosis. Re-anastomosis was achieved in an average of 6 days (range 3 to 7 days) in 5 patients (age 6 months to 5.9 years) with severe recurrent postsurgical esophageal stenosis refractory to dilatation. Primary esophageal anastomosis was achieved in an average of 4.2 days (range 3 to 6 days) in 9 patients with esophageal atresia (Type A or Type C surgically converted to Type A) with a gap length of 4 cm or less. The average age of these esophageal atresia patients was 3 months (range 23 days to 5 months). CONCLUSION Minimally invasive magnet placement was feasible and achieved anastomosis in all patients.
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Affiliation(s)
- Mario Zaritzky
- Department of Radiology, The University of Chicago Medicine, Comer Children's Hospital, 5721S. Maryland Avenue, Chicago, IL 60637, USA.
| | - Ricardo Ben
- Department of Gastroenterology, Hospital de Niños de La Plata, Calle 14 Nro 1631, La Plata, Buenos Aires, Argentina
| | - Krystal Johnston
- MED Institute, Inc., 1 Geddes Way, West Lafayette, IN 47906, USA
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Histopathologic advantages of compression ring anastomosis healing as compared with stapled anastomosis in a porcine model: a blinded comparative study. Dis Colon Rectum 2014; 57:506-13. [PMID: 24608308 DOI: 10.1097/dcr.0000000000000009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The performances of compression and stapled devices were compared previously in porcine colorectal anastomosis. The compression anastomosis was associated with elevated bursting strength and anastomotic patency in this model as compared with the stapled anastomosis. OBJECTIVE The purpose of this work was to compare the histopathologic features between compression and stapled methods in the healing of colorectal anastomoses using a porcine model. DESIGN This was a blinded comparison study. SETTINGS The study was conducted at a single university surgery department. PATIENTS Fifty crossbred pigs were used in this study. MAIN OUTCOME MEASURES Fifty crossbred pigs underwent rectal transection 20 cm from the anal verge and end-to-end compression or stapled anastomosis. The anastomotic tissues were harvested 3, 7, 30, and 90 days postoperatively (n = 5-6). Tissue repair parameters associated with the wound healing were analyzed using image analysis morphometry and histological architecture assessments. RESULTS A different microscopic pattern of the anastomotic area was shown between groups. Foreign body response was rated (p < 0.001) as minimal in the compression and moderate in the stapled group. The scarring area in the compression anastomosis group, on postoperative day 90 (4 ± 3 × 10(5) μm) was lower (p = 0.016) than in the stapled group (2 ± 1 × 10(6) μm). In addition, the anastomotic line was narrower (p = 0.003) 90 days after surgery in the compression samples (0.77 ± 0.20 mm) compared with that in the stapled group (1.86 ± 0.19 mm). Lastly, in terms of inflammatory cells, the compression biopsies showed lower (p < 0.001) numbers of mononuclear cells, polymorphonuclear cells, and lymphocytes in the anastomotic tissues 30 and 90 days from surgery. LIMITATIONS The long-term effect of the compression technique on the anastomotic patency in colorectal anastomoses should be further investigated in human studies. CONCLUSIONS Compression anastomotic healing was associated with less foreign body reactions, scarring, and inflammation as compared with stapled anastomoses in a large animal model.
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Kusnierz K, Lekston Z, Zhavoronkov D, Mrowiec S, Lampe P. A nickel–titanium memory-shape device for gastrojejunostomy: comparison of the compression anastomosis clip and a hand-sewn anastomosis. J Surg Res 2014; 187:94-100. [DOI: 10.1016/j.jss.2013.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 01/13/2023]
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A modular magnetic anastomotic device for minimally invasive digestive anastomosis: proof of concept and preliminary data in the pig model. Surg Endosc 2014; 28:1613-23. [DOI: 10.1007/s00464-013-3360-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/28/2013] [Indexed: 12/24/2022]
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Dauser B, Braunschmid T, Ghaffari S, Riss S, Stift A, Herbst F. Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg 2013; 398:957-64. [PMID: 23943311 DOI: 10.1007/s00423-013-1103-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 07/29/2013] [Indexed: 01/20/2023]
Abstract
PURPOSE Surgical technique and perioperative management in rectal cancer surgery have been substantially improved and standardized during the last decades. However, anastomotic leakage following low anterior resection still is a significant problem. Based on animal experimental data of improved healing of compression anastomosis, we hypothesized that a compression anastomotic device might improve healing rates of the highest-risk anastomoses. METHODS All low anterior resections for rectal cancer performed or directly supervised by the senior author between January 2004 and June 2012 were analyzed. Only patients with a stapled or compression anastomosis located within 6 cm from the anal verge were included. Until December 2008, circular staplers were employed, while since January 2009, a novel compression anastomotic device was used for rectal reconstruction exclusively. RESULTS Out of 197 patients operated for rectal cancer, a total of 96 (34 females, 35.4 %) fulfilled inclusion criteria. Fifty-eight (60.4 %) were reconstructed with circular staplers and 38 (39.6 %) using a compression anastomotic device. Significantly, more laparoscopic procedures were recorded in the compression anastomosis group, but distribution of gender, age, body mass index, American Society of Anaesthesiologists score, rate of preoperative radiotherapy, tumor staging, or stoma diversion rate were similar. Anastomotic leakage was observed in seven cases (7/58, 12.1 %) in the stapled and twice (2/38, 5.3 %) in the compression anastomosis group (p = 0.26). CONCLUSIONS In this series, rectal reconstruction following low anterior resection using a novel compression anastomotic device was safe and (at least) equally effective compared to traditional circular staplers concerning leak rate.
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Affiliation(s)
- Bernhard Dauser
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria
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Lambe T, Ríordáin MGÓ, Cahill RA, Cantillon-Murphy P. Magnetic compression in gastrointestinal and bilioenteric anastomosis: how much force? Surg Innov 2013; 21:65-73. [PMID: 23592733 DOI: 10.1177/1553350613484824] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The concept of compression alimentary anastomosis is well established. Recently, magnetic axial alignment pressures have been encompassed within such device constructs. We quantify the magnetic compression force and pressure required to successfully achieve gastrointestinal and bilioenteric anastomosis by in-depth interrogation of the reported literature. METHODS Reports of successful deployment and proof of anastomotic patency on survival were scrutinized to quantify the necessary dimensions and strengths of magnetic devices in (a) gastroenteral anastomosis in live porcine models and (b) bilioenteric anastomosis in the clinical setting. Using a calculatory tool developed for this work (magnetic force determination algorithm, MAGDA), ideal magnetic force and compression pressure were quantified from successful reports with regard to their variance by intermagnet separation. RESULTS Optimized ranges for both compression force and pressure were determined for successful porcine gastroenteral and clinical bilioenteric anastomoses. For gastroenteral anastomoses (porcine investigations), an optimized compression force between 2.55 and 3.57 kg at 2-mm intermagnet separation is recommended. The associated compression pressure should not exceed 60 N/cm(2). Successful bilioenteric anastomoses is best clinically achieved with intermagnet compression of 18 to 31 g and associated pressures between 1 and 3.5 N/mm(2) (at 2-mm intermagnet separation). CONCLUSION The creation of magnetic compression anastomoses using permanent magnets demonstrates a remarkable resilience to variations in magnetic force and pressure exertion. However, inappropriate selection of compression characteristics and magnet dimensions may incur difficulties. Recommendations of this work and the availability of the free online tool (http://magda.ucc.ie/) may facilitate a factor of robustness in the design and refinement of future devices.
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Kopelman D, Kopelman Y, Peled D, Willenz U, Zmora O, Wasserberg N. Healing of ileocolic nitinol compression anastomosis: a novel porcine model of subtotal colectomy. Surg Innov 2013; 20:570-9. [PMID: 23575914 DOI: 10.1177/1553350613484592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are limited large animal models for the research of novel anastomotic technologies. Subtotal colectomy requires the anastomosis of relatively remote segments of the alimentary tract that are different anatomically, histologically, and pose significant physiological challenge. The quest for a foreign material-free anastomotic line reintroduced nitinol compression anastomosis into clinical use in the last decade. OBJECTIVE To evaluate the safety, histological, and physiological parameters of side-to-side ileocolic nitinol compression anastomosis in a newly developed large animal model, mimicking the human subtotal colectomy. INTERVENTION Resection of the entire spiral colon with an ileocolic side-to-side compression anastomosis in 12 animals, compared to resection of a short ileal segment in 6 animals. All anastomoses were constructed by using a novel nitinol-based compression device. The animals were followed up to 30 days postoperatively and were reoperated and sacrificed. RESULTS All 12 animals underwent successful subtotal colectomy with side-to-side nitinol compression anastomosis. No signs of abdominal infection were found. The increase in the colectomized animals' bodyweight over the postoperative course was significantly lower and the animals presented with longer periods of diarrhea. The histopathology revealed minimal inflammation and foreign body reaction with good alignment of the bowel wall layers in both groups. The anastomotic line width was shown to be reduced during the healing course of the compression anastomoses. CONCLUSIONS Side-to-side nitinol compression anastomosis is safe and demonstrates favorable functional and histopathological features. The porcine model of subtotal colectomy can be used for further research of novel anastomotic technologies.
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Affiliation(s)
- Doron Kopelman
- 1Dept. of surgery B', HaEmek medical center, Faculty of medicine of the Technion, Israel institute of technology
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Kusnierz K, Morawiec H, Lekston Z, Zhavoronkov D, Lucyga M, Lampe P. NiTi Shape Memory Compression Anastomosis Clip in Small- and Large-Bowel Anastomoses. Surg Innov 2013; 20:580-5. [DOI: 10.1177/1553350612474494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to present a clinical use of compression anastomosis clip (CAC) implants made of shape memory materials—nickel titanium alloys (NiTi). The concept involved in the use of CAC was to compress 2 bowel walls together, cause necrosis, and detach the CAC from the tissue to be expelled with the stool. The CAC is a double-ring elliptical device with a diameter of 30 mm. The device has the ability to recover its original closed shape when it senses a change in ambient temperature. In all, 20 anastomoses using CACs were performed: 6 of the small with the large bowel and 14 between the small bowel and small bowel. Two patients experienced complications. Although the anastomosis is not difficult to perform, the rules on how to apply the CAC must be well known. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study.
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Compression anastomosis ring device in colorectal anastomosis: a review of 1,180 patients. Am J Surg 2013; 205:447-51. [PMID: 23290352 DOI: 10.1016/j.amjsurg.2012.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/19/2012] [Accepted: 03/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The nickel-titanium compression anastomosis ring device (ColonRing, NiTi Surgical Solutions, Netanya, Israel) has been cleared by the Food and Drug Administration in 2006 to construct gastrointestinal anastomoses. We evaluated the anastomotic leak rate after end-to-end anastomosis using the ColonRing device. METHODS Using a multinational (16 countries), multicenter (178 centers) data registry provided by NiTi Surgical Solutions, Netanya, Israel, we retrospectively examined clinical data of patients who underwent elective laparoscopic or open left-sided colectomy and anterior resection from January 2008 to June 2010. RESULTS A total of 1,180 patients underwent end-to-end anastomosis using the ColonRing device during the study period. The overall anastomotic leak rate was 3.22% (38 patients). The median length of hospital stay was 6 days (range 2 to 21 days). The median ring expulsion time was 8 days. The earliest ring expulsion time was 6 days; however, in 1 patient, the ring did not expel. In 4 patients, the anastomosis had to be immediately recreated because of 1 misfiring and 3 incomplete anastomoses. CONCLUSIONS The use of the ColonRing device is feasible and safe and could be considered an alternative technology for end-to-end colorectal anastomosis.
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Schroeter M, Wildemann B, Lendlein A. Biodegradable Materials. Regen Med 2013. [DOI: 10.1007/978-94-007-5690-8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Marano L, Braccio B, Schettino M, Izzo G, Cosenza A, Grassia M, Porfidia R, Reda G, Petrillo M, Esposito G, Di Martino N. Sutureless jejuno-jejunal anastomosis in gastric cancer patients: a comparison with handsewn procedure in a single institute. BMC Surg 2012; 12 Suppl 1:S27. [PMID: 23173807 PMCID: PMC3499244 DOI: 10.1186/1471-2482-12-s1-s27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The biofragmentable anastomotic ring has been used to this day for various types of anastomosis in the gastrointestinal tract, but it has not yet achieved widespread acceptance among surgeons. The purpose of this retrospective study is to compare surgical outcomes of sutureless with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer. METHODS Two groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient. RESULTS The mean time spent to complete a sutureless anastomosis was 11 ± 4 min, whereas the time spent to perform hand sewn anastomosis was 23 ± 7 min. Estimated intraoperative blood loss was 178 ± 32 ml in the sutureless group and 182 ± 23 ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups. CONCLUSIONS The Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless currently there are few studies on upper gastrointestinal sutureless anastomoses and this could be the reason for the low uptake of this device.
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Affiliation(s)
- Luigi Marano
- Institution VIII General and Gastrointestinal Surgery, Chief Prof N Di Martino, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
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Kim HR, Lee WY, Jung KU, Yun HR, Cho YB, Yun SH, Kim HC, Chun HK. Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy. J Laparoendosc Adv Surg Tech A 2012; 22:472-8. [PMID: 22670638 DOI: 10.1089/lap.2011.0406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The NiTi endoluminal Compression Anastomotic Clip (CAC™) 30 (NiTi CAC 30) (NiTi Alloys Technologies, Ltd., Netanya, Israel) is a new device with shape-memory characteristics. We aimed to investigate the safety and early surgical outcomes of NiTi CAC 30 for intestinal anastomosis in patients with gastrointestinal malignancy. SUBJECTS AND METHODS Fifty patients operated on with NiTi CAC 30 were matched for sex, age, body mass index, operation type (open versus laparoscopy), operation name, and anastomosis type with patients in a control group operated on with a stapling device between November 2009 and May 2010. Early clinical outcomes were investigated. RESULTS One misfired case of NiTi CAC 30 was excluded. Between the two groups, no significant differences were observed in demographics except for previous abdominal operation history. The results of early clinical outcomes were investigated, including operation time, estimated blood loss, time to first flatus, first defecation, and discharge, and complications. No differences were noted. Postoperatively, migration started in 1 patient between 3 and 5 days, 11 patients between 6 to 7 days, and 37 patients after 8 days. The expulsion of 31 cases occurred between 2 and 3 weeks, postoperatively. The NiTi CAC 30 was expulsed within 1 week in 4 patients and between 1 to 2 weeks in 8 patients. An expulsion occurred in 1 case at over 4 weeks. No problems related to early migration and expulsion were observed, and no anastomotic leakage and bleeding occurred. CONCLUSIONS Intestinal anastomosis with the NiTi CAC 30 was safe and feasible without anastomotic leakage and reoperation compared with the stapling technique.
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Affiliation(s)
- Hyoung Ran Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Kang J, Park MG, Hur H, Min BS, Lee KY, Kim NK. Safety and efficacy of the NiTi Shape Memory Compression Anastomosis Ring (CAR/ColonRing) for end-to-end compression anastomosis in anterior resection or low anterior resection. Surg Innov 2012; 20:164-70. [PMID: 22696026 DOI: 10.1177/1553350612449073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Compression anastomoses may represent an improvement over traditional hand-sewn or stapled techniques. This prospective exploratory study aimed to assess the efficacy and complication rates in patients undergoing anterior resection (AR) or low anterior resection (LAR) anastomosed with a novel end-to-end compression anastomosis ring, the ColonRing. METHODS In all, 20 patients (13 male) undergoing AR or LAR were enrolled to be anastomosed using the NiTi Shape Memory End-to-End Compression Anastomosis Ring (NiTi Medical Technologies Ltd, Netanya, Israel). Demographic, intraoperative, and postoperative data were collected. RESULTS Patients underwent AR (11/20) or LAR using laparoscopy (75%), robotic (10%) surgery, or an open laparotomy (15%) approach, with a median anastomotic level of 14.5 cm (range, 4-25 cm). Defunctioning loop ileostomies were formed in 6 patients for low anastomoses. Surgeons rated the ColonRing device as either easy or very easy to use. One patient developed an anastomotic leakage in the early postoperative period; there were no late postoperative complications. Mean time to passage of first flatus and commencement of oral fluids was 2.5 days and 3.2 days, respectively. Average hospital stay was 12.6 days (range, 8-23 days). Finally, the device was expelled on average 15.3 days postoperatively without difficulty. CONCLUSIONS This is the first study reporting results in a significant number of LAR patients and the first reported experience from South Korea; it shows that the compression technique is surgically feasible, easy to use, and without significant complication rates. A large randomized controlled trial is warranted to investigate the benefits of the ColonRing over traditional stapling techniques.
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Affiliation(s)
- Jeonghyun Kang
- Yonsei University College of Medicine, Seoul, South Korea
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Compression anastomoses in colon and rectal surgery with the NiTi ColonRing™. Tech Coloproctol 2011; 16:29-35. [PMID: 22139026 DOI: 10.1007/s10151-011-0794-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 11/18/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this prospective study was to evaluate safety and efficacy of the NiTi ColonRing™ for anastomoses on the colon or rectum. METHODS During the period September 2008-June 2011, anastomosis using the NiTi ColonRing™ was scheduled to be performed on 60 patients (36 females, 24 males/mean aged 67 years), 53 of whom underwent colectomy for cancer and 7 reconstruction after Hartmann's procedure. Application of the device failed in one case due to anatomical reasons. Colorectal resections performed were as follows: Right hemicolectomy (5 patients), left colectomy (2), sigmoidectomy (15) and low anterior resection (31). A follow-up clinic visit after 1 month was planned for all patients. Ten patients among the first 14 had rectosigmoidoscopy at 2-3 months. All cancer patients were scheduled for colonoscopy at 12 months. RESULTS No intraoperative or postoperative bleeding related to the anastomotic technique was recorded. Median hospital stay after surgery was 10.2 days (9-22 days). One patient died on day 13 due to myocardial infarction. Clinically apparent leak was detected in one patient who had undergone reconstruction after Hartmann; the only treatment required was total parenteral nutrition for 12 days. Anastomotic stenosis occurred in another one patient who had undergone reconstruction after Hartmann; it was easily resolved by balloon dilatation. Mild complications were encountered in 23 other patients (39%). Oral feeding started after day 4. Anastomotic rings were expelled naturally within 7-17 days (mean, 9.2 days). A satisfactory anastomosis was revealed in patients examined colonoscopically at 2-3 and 12 months. Mean follow-up was 15.2 months (2-33 months). CONCLUSIONS NiTi ColonRing™ is reliable, safe and efficacious for large bowel anastomoses.
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Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis. ACTA ACUST UNITED AC 2011; 26:182-9. [DOI: 10.1016/s1001-9294(11)60046-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Compression Anastomosis Revisited: Prospective Audit of Short- and Medium-term Outcomes in 62 Rectal Anastomoses. World J Surg 2011; 35:1925-32. [DOI: 10.1007/s00268-011-1135-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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van Hooft JE, Vleggaar FP, Le Moine O, Bizzotto A, Voermans RP, Costamagna G, Devière J, Siersema PD, Fockens P. Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 2010; 72:530-5. [PMID: 20656288 DOI: 10.1016/j.gie.2010.05.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 05/20/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Palliation of malignant gastric outlet obstruction remains challenging. Although there are 2 established treatment options, ie, surgical gastrojejunostomy and endoscopic duodenal stent insertion, there is an ongoing search for a technique that would combine the safety and rapid effect of duodenal stent placement with the long-term efficacy and low reintervention rate of a surgical gastrojejunostomy. OBJECTIVE To investigate the safety and success rate of endoscopic creation of a gastroenteric anastomosis formed by magnetic compression and stent placement. DESIGN Prospective, multicenter cohort study. SETTING Four referral centers. PATIENTS The expected number of patients with symptomatic malignant gastric outlet obstruction to be included at the participating hospitals during a year was 40. Because of a serious adverse device event, the study was terminated after inclusion of 18 patients. INTERVENTION Creation of an endoscopic gastroenteric anastomosis by using the Cook Magnetic Anastomosis Device with transanastomotic deployment of a self-expandable stent. MAIN OUTCOME MEASUREMENTS Primary endpoints were safety and success rate associated with the creation of an endoscopic gastrojejunostomy by using a magnetic anastomotic device with transanastomotic deployment of a self-expandable stent. RESULTS Because of a serious adverse event, the study was terminated prematurely. A success rate of 66.7% (12 of 18 patients) was achieved; 1 serious adverse event (stent perforation) occurred leading to the death of the patient. Three patients (25%) experienced an adverse device effect (stent migration). LIMITATIONS Small sample size, lack of a control group. CONCLUSION Endoscopic creation of a gastroenteric anastomosis by magnetic compression is feasible and safe; however, the necessity of a stent led to serious morbidity and even mortality in this study. The current system can therefore not be recommended for clinical use.
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Affiliation(s)
- Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety aspects of anastomosis and alternatives to hand-sewn and stapled techniques are being sought. Here, we review alternative anastomotic techniques used to fashion bowel anastomosis. Compression anastomosis using compression anastomotic clips, endoluminal compression anastomotic rings, AKA-2, biofragmental anastomotic rings, or Magnamosis all involve the concept of creating a sutureless end-to-end anastomosis by compressing two bowel ends together, leading to a simultaneous necrosis and healing process that joins the two lumens. Staple line reinforcement is a new approach that reduce the drawbacks of staplers used in colorectal practice, i.e. leakage, bleeding, misfiring, and inadequate tissue approximation. Various non-absorbable, semi or fully absorbable materials are now available. Two other techniques can provide alternative anastomotic support to the suture line: a colorectal drain and a polyester stent, which can be utilized in ultra-low rectal excision and can negate the formation of a defunctioning stoma. Doxycycline coated sutures have been used to overcome the post-operative weakness in anastomosis secondary to rapid matrix degradation mediated by matrix metalloproteinase. Another novel technique, the electric welding system, showed promising results in construction of a safe, neat, smooth sutureless bowel anastomosis. Various anastomotic techniques have been shown to be comparable to the standard techniques of suturing and stapling. However, most of these alternatives need to be accepted and optimized for future use.
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Myers C, Yellen B, Evans J, DeMaria E, Pryor A. Using external magnet guidance and endoscopically placed magnets to create suture-free gastro-enteral anastomoses. Surg Endosc 2009; 24:1104-9. [PMID: 20033734 DOI: 10.1007/s00464-009-0735-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 10/02/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND To facilitate endolumenal and natural orifice procedures, this study evaluated a novel technique using external and endoscopically placed magnets to create suture-free gastroenteral anastomoses. METHODS Seven anesthetized adult swine underwent endoscopic placement of magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1-2 weeks, the pigs were killed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were obtained. The anastomoses were evaluated endoscopically and tested using an air insufflation test. Finally, the anastomoses were resected and evaluated microscopically. RESULTS The average operative time for endoscopic placement of the magnets was 34.3 +/- 14.8 min. Successful placement and creation of anastomoses occurred in six of the pigs. One pig did not form an anastomosis because the magnets were too large to pass through the pylorus at the time of attempted magnet placement. Six swine experienced uncomplicated postoperative courses. One pig's postoperative course involved constipation for several days, requiring additional fluids and fiber supplementation. The findings at endoscopy showed that the magnets were adhered to the anastomosis, which were easily freed, or within the stomach. The air insufflation test results were negative for all the pigs. At laparotomy, there was no evidence of infection, abscess, or leak, but two peritoneal culture results were positive with scant growth of Staphylococcus aureus and coagulase-negative staphylococcus, presumably contaminants. Microscopically, the anastomoses illustrated granulation and fibrous connective tissue without evidence of infection or leak. CONCLUSION Endoscopically placed magnets with external magnet guidance is a feasible and novel approach to creating patent gastroenteral anastomoses without abdominal incisions or sutures.
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Affiliation(s)
- Christopher Myers
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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