MAGNAMOSIS IV: magnetic compression anastomosis for minimally invasive colorectal surgery

Background and study aims: MAGNAMOSIS forms a compression anastomosis using self-assembling magnetic rings that can be delivered via flexible endoscopy. The system has proven to be effective in full-thickness porcine small-bowel anastomoses. The aim of this study was to show the feasibility of the MAGNAMOSIS system in hybrid endoscopic colorectal surgery and to compare magnetic and conventional stapled anastomoses.

Methods: A total of 16 swine weighing 35 – 50 kg were used following animal ethical committee approval. The first animal was an acute model to establish the feasibility of the procedure. The subsequent 15 animals were survival models, 10 of which underwent side-to-side anastomoses (SSA) and 5 of which underwent end-to-side (ESA) procedures. Time to patency, surveillance endoscopy, burst pressure, compression force, and histology were assessed. Histology was compared with conventional stapled anastomoses. Magnetic compression forces were measured in various anastomosis configurations.

Results: Colorectal anastomoses were performed in all cases using a hybrid NOTES technique. The mean operating time was 71 minutes. Mean time to completion of the anastomosis was similar between the SSA and ESA groups. Burst pressure at 10 days was greater than 95 mmHg in both groups. One complication occurred in the ESA group. Compression force among various configurations of the magnetic rings was significantly different (P < 0.05). Inflammation and fibrosis were similar between magnetic SSA and conventional stapled anastomoses.

Conclusion: MAGNAMOSIS was feasible in performing a hybrid NOTES colorectal anastomosis. It has the advantage over circular staplers of precise endoscopic delivery throughout the entire colon. SSA was reliable and effective. A minimum initial compression force of 4 N appears to be required for reliable magnetic anastomoses.

• References

• 1 Aggarwal R, Darzi A. Compression anastomoses revisited. J Am Coll Surg 2005; 201: 965-971
• 2 Kopelman D, Hatoum OA, Kimmel B et al. Compression gastrointestinal anastomosis. Expert Rev Med Devices 2007; 4: 821-828
• 3 Hardy KJ. Non-suture anastomosis: the historical development. Aust N Z J Surg 1990; 60: 625-633
• 4 Senn N. Enterorrhaphy; its history, technique, and present status. JAMA 1893; 21: 215-235
• 5 Mokros W. [The indications for the Valtrac-ring – Report on 1015 Anastomoses]. Zentralbl Chir 2001; 126: 1005-1008
• 6 Cahill CJ, Betzler M, Gruwez JA et al. Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring. Br J Surg 1989; 76: 344-347
• 7 Forde KA, Goodell KH, DellaBadia M. A 10-year single-institutional study of the biofragmentable anastomosis ring. Am J Surg 2006; 191: 483-487 ; discussion 488
• 8 Bundy CA, Zera RT, Onstad GA et al. Comparative surgical and colonoscopic appearance of colon anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring. Surg Endosc 1992; 6: 18-22
• 9 Galizia G, Lieto E, Castellano P et al. Comparison between the biofragmentable anastomosis ring and stapled anastomoses in the extraperitoneal rectum: a prospective, randomized study. Int J Colorectal Dis 1999; 14: 286-290
• 10 Polglase AL, Skinner SA, Johnson WR. Laparoscopic assisted right hemicolectomy with Valtrac BAR (Biofragmentable Anastomotic Ring) ileotransverse anastomosis. Aust N Z J Surg 1993; 63: 481-484
• 11 Gullichsen R, Ovaska J, Havia T et al. What happens to the Valtrac anastomosis of the colon?. A follow-up study. Dis Colon Rectum 1993; 36: 362-365
• 12 Corman ML, Prager ED, Hardy Jr TG et al. Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum 1989; 32: 183-187
• 13 Kim SH, Choi HJ, Park KJ et al. Sutureless intestinal anastomosis with the biofragmentable anastomosis ring: experience of 632 anastomoses in a single institute. Dis Colon Rectum 2005; 48: 2127-2132
• 14 Jansen A, Keeman JN, Davies GA et al. Early experiences with magnetic rings in resection of the distal colon. Neth J Surg 1980; 32: 20-27
• 15 Jansen A, Brummelkamp WH, Davies GA et al. Clinical applications of magnetic rings in colorectal anastomosis. Surg Gynecol Obstet 1981; 153: 537-545
• 16 Jamshidi R, Stephenson JT, Clay JG et al. Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg 2009; 44: 222-228
• 17 Pichakron KO, Jelin EB, Hirose S et al. Magnamosis II: magnetic compression anastomosis for minimally invasive gastrojejunostomy and jejunojejunostomy. J Am Coll Surg 2011; 212: 42-49
• 18 Gonzales KD, Douglas G, Pichakron KO et al. Magnamosis III: delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques. J Pediatr Surg 2012; 47: 1291-1295
• 19 Diana M, Wall J, Perretta S et al. Totally endoscopic magnetic enteral bypass by external guided rendez-vous technique. Surg Innov 2011; 18: 317-320
• 20 Leroy J, Perretta S, Diana M et al. An original endoluminal magnetic anastomotic device allowing pure NOTES transgastric and transrectal sigmoidectomy in a porcine model: proof of concept. Surg Innov 2012; 19: 109-116
• 21 Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 2006; 20: 329-333
• 22 Leroy J, Costantino F, Cahill RA et al. Fully laparoscopic colorectal anastomosis involving percutaneous endoluminal colonic anvil control (PECAC). Surg Innov 2010; 17: 79-84
• 23 Perretta S, Wall JK, Dallemagne B et al. Two novel endoscopic esophageal lengthening and reconstruction techniques. Surg Endosc 2011; 25: 3440
• 24 Diana M, Leroy J, Wall J et al. Prospective experimental study of transrectal viscerotomy closure using transanal endoscopic suture vs. circular stapler: a step toward NOTES. Endoscopy 2012; 44: 605-611