Magnamosis III: delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques.
OBJECTIVE
Magnamosis creates a secure sutureless anastomosis through magnetic compression. In this study, we further develop and test delivery devices capable of creating a secure duodeno-colonic anastomosis using available minimally invasive endoscopic techniques.


METHODS
Eight pigs underwent general anesthesia. Colonoscopy was used to deliver 1 magnetic ring to the hepatic flexure. Simultaneously, upper endoscopy delivered the other magnetic ring into the duodenum using a variety of techniques. The 2 magnetic rings were brought into magnetic proximity under laparoscopic guidance. The pigs were recovered and examined daily followed by sacrificing at 1, 2, 4, and 6 weeks.


RESULTS
The device designed to deliver and release each magnetic ring evolved from using a guide wire and balloon devices to redesigning the magnetic ring casing with a groove to accommodate an endoscopic snare. Laparoscopic visualization assured safe magnet mating of intestinal segments. The duodeno-colonic anastomoses created with the snare yielded widely patent anastomoses. In vitro testing revealed excellent burst pressure. Histology revealed complete healing as early as 1 week.


CONCLUSIONS
We redesigned the magnamosis device to facilitate delivery by endoscopic techniques. The snare technique allows endoscopic positioning and controlled release of the magnetic rings for a secure side-to-side duodeno-colonic anastomosis.
Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0570, USA.
Kelly D
KD
Gonzales
Geoffrey
G
Douglas
Kullada O
KO
Pichakron
Dillon A
DA
Kwiat
Salvador Guevara
SG
Gallardo
Jose Luis
JL
Encinas
Shinjiro
S
Hirose
Michael R
MR
Harrison
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D003106:Colon / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D004386:Duodenum / Q000473:pathology / Q000601:surgery; D020007:Implants, Experimental; D008280:Magnetics / Q000295:instrumentation*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods*; D013270:Stomach / Q000473:pathology / Q000601:surgery; D034421:Sus scrofa; D013552:Swine; D013718:Tensile Strength; D014945:Wound Healing