title: Magnetic compression in gastrointestinal and bilioenteric anastomosis: how much force?
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1University College Cork, Cork, Ireland.
authors.forename: Tadhg
authors.initials: T
authors.lastname: Lambe
authors.forename: Mícheál G Ó
authors.initials: MG
authors.lastname: Ríordáin
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Cahill
authors.forename: Pádraig
authors.initials: P
authors.lastname: Cantillon-Murphy
mesh_terms: D000465:Algorithms; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D008280:Magnetics; D023421:Models, Animal; D011312:Pressure; D012984:Software; D013552:Swine
keywords: bilioenteric anastomosis; gastrointestinal anastomosis; magnetic compression anastomosis; minimally invasive surgery; surgical device; surgical innovation