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Hybrid fluorescent magnetic gastrojejunostomy: an experimental feasibility study in the porcine model and human cadaver

  • Ryohei Watanabe
  • Manuel BarberioEmail author
  • Shingo Kanaji
  • Alfonso Lapergola
  • Anila Hoskere Ashoka
  • Bohdan Andreiuk
  • Ludovica Guerriero
  • Margherita Pizzicannella
  • Barbara Seeliger
  • Yoshihisa Saida
  • Hironori Kaneko
  • Marc Worreth
  • Alend Saadi
  • Jacques Marescaux
  • Andrey S. Klymchenko
  • Michele Diana
2019 EAES Oral
  • 98 Downloads

Abstract

Background

Laparoscopic gastrojejunostomies are time consuming and require a specific training. Alternatively, sutureless anastomosis can be achieved using endoscopically delivered magnetic rings. Our aim was to assess the feasibility and reproducibility of an endo-laparoscopic gastrojejunostomy technique, using a pair of magnets coated with a near-infrared fluorescent biocompatible polymeric material.

Methods

Five pigs (3 acute and 2 survival models) and one human anatomical specimen were included. In the survival models, the distal ring was inserted into the duodenum endoscopically, and it was fixed to a thread clipped to the gastric mucosa. Twenty-four hours later, a two-port laparoscopy was performed using a near-infrared (NIR) laparoscope. The magnet position in the jejunum was detected with the transluminal fluorescence of the dye. Magnetic interaction with the metallic tip of the laparoscopic grasper allowed to capture the ring and bring the bowel loop to the future anastomotic site on the gastric wall. The proximal magnet was inserted into the stomach endoscopically and released when magnetic interaction started, allowing for a precise connection with the distal ring. The animals were followed up for 12 days and underwent control endoscopies and radiograms. In the acute animals, the anastomotic procedure was repeated 24 times. Finally, the procedure was performed in the human anatomical specimen.

Results

There were no technical problems, and magnetic connection could be precisely directed at both the anterior and posterior gastric walls. No complications occurred during the survival period and the anastomoses were patent on day 5. Transluminal fluorescence enabled a rapid detection of the magnet.

Conclusions

Hybrid-reduced port magnetic gastrojejunostomy using a pair of fluorescently coated magnetic rings was feasible, reproducible, and easy to perform in both porcine and cadaver models.

Keywords

Sutureless anastomose Magnetic compression anastomose Near-infrared coating Hybrid surgical procedure 

Notes

Acknowledgements

Authors are grateful to Camille Goustiaux, Guy Temporal, and Christopher Burel, professionals in Medical English proofreading for their valuable help with the manuscript revision.

Funding

This study was partly funded by a grant from the ARC Foundation for Cancer Research (9, rue Guy Môquet; 94803 Villejuif Cedex—France; www.fondation-arc.org), in the framework of the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) project, and partly by a grant from the Society to Accelerate Tech Transfer (SATT) Conectus Alsace (650 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France), in the framework of the NICE (Near-Infrared Coating of Equipment) project.

Compliance with ethical standards

Disclosures

Michele Diana is the PI of the ELIOS project and co-PI of the NICE project. Andrey Klymchenko is co-PI of the NICE project. Both are inventors of the NICE technology (European patent application No. 18305075.6). Jacques Marescaux is the President of both IRCAD and IHU Institutes, which are partly funded by KARL STORZ, Medtronic, and Siemens Healthcare. Ryohei Watanabe, Manuel Barberio, Shingo Kanaji, Alfonso Lapergola, Anila Hoskere Ashoka, Bohdan Andreiuk, Ludovica Guerriero, Margherita Pizzicannella, Barbara Seeliger, Yoshihisa Saida, Hironori Kaneko, Marc Worreth, and Alend Saadi have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 206532 kb)

Supplementary material 2 (MP4 45071 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ryohei Watanabe
    • 1
    • 2
    • 3
  • Manuel Barberio
    • 1
    Email author
  • Shingo Kanaji
    • 3
  • Alfonso Lapergola
    • 1
  • Anila Hoskere Ashoka
    • 4
  • Bohdan Andreiuk
    • 4
  • Ludovica Guerriero
    • 1
  • Margherita Pizzicannella
    • 1
  • Barbara Seeliger
    • 1
  • Yoshihisa Saida
    • 2
  • Hironori Kaneko
    • 2
  • Marc Worreth
    • 5
  • Alend Saadi
    • 5
  • Jacques Marescaux
    • 1
    • 3
  • Andrey S. Klymchenko
    • 4
  • Michele Diana
    • 1
    • 3
    • 5
  1. 1.IHU-Strasbourg, Institute of Hybrid Image-Guided SurgeryStrasbourgFrance
  2. 2.Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
  3. 3.IRCAD, Research Institute Against Digestive CancerStrasbourgFrance
  4. 4.Laboratoire de Bioimagerie et PathologiesUMR 7021, CNRS, Université de StrasbourgIllkirch-StrasbourgFrance
  5. 5.Department of SurgeryNeuchâtel HospitalNeuchâtelSwitzerland

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