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Clinical cases treated by magnetic compression anastomosis (MCA) for different causes and types of intestinal stenosis/ atresia to successfully achieve intestinal recanalization were reviewed, so as to explore the clinical application of MCA. From May 2019 to August 2022, 4 patients underwent colorectal MCA for intestinal recanalization in the First Affiliated Hospital of Xi'an Jiaotong University and Northwest Women and Children's Hospital. All operations went well, and the intestinal anastomosis was recanalized. The magnetic ring was discharged in 7-15 days, and the postoperative colonoscopy or radiography showed that the anastomosis was intact. MCA can be used to treat different types of colorectal stenosis and atresia due to different reasons, and can also be used to assist intestinal anastomosis in colorectal surgery.
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@#Objective To investigate the feasibility of magnamosis rings designed based on magnetic compression technique in esophageal anastomosis reconstruction. Methods According to the anatomical characteristics of esophagus in SD rats, the esophageal magnamosis rings were designed. SD rats were used as animal models (n=10, 5 males and 5 females) to complete the magnetic anastomosis reconstruction of the cervical esophagus using magnamosis rings, and the operation time, animal survival, postoperative complications, magnetic rings excretion time were recorded. Two weeks after operation, the rats were killed, and the esophageal anastomotic specimens were obtained. The blasting pressure of the anastomotic site was measured and the formation of the anastomotic site was observed with naked eyes. Results Esophageal magnamosis was successfully performed in 10 SD rats, and the median operation time was 11 (8-13) min. All rats survived without anastomotic leakage, anastomotic stenosis, or magnetic rings incarceration. The magnetic rings were discharged after 8 (5-10) days and the burst pressure was higher than 300 mm Hg. Visual observation showed that the anastomotic muscle healed well and the mucosa was smooth. Conclusion The magnetic compression technique can be used for anastomosis reconstruction of esophagus, which has the advantages of simple operation and reliable anastomosis effect, and has clinical application prospect.
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@#Objective To investigate the feasibility of using magnetic beads to locate small pulmonary nodules. Methods Twelve rabbits were randomly divided into two groups, 6 in each group. One group underwent thoracotomy after anesthesia and the other group underwent percutaneous puncture under the guidance of X-ray. One and two cylindrical tracer magnets (magnetic beads) with a diameter of 1 mm and a height of 3 mm were injected adjacent to the imaginary pulmonary nodules in left lung in each group. The magnetic beads beside the imaginary nodules were attracted by a pursuit magnet with a diameter of 9 mm and a height of 19 mm. The effectiveness of localization by magnetic beads were determined by attraction between tracer and pursuit magnets. Results All processes were uneven in 12 rabbits. There was micro hemorrhage and no hematoma in the lung tissue at the injection site of the magnetic beads. When tracked with the pursuit magnets, there was one bead divorce in cases that one bead was injected, but no migration or divorce of the magnetic beads in cases that two magnetic beads were simultaneously injected to localize the small pulmonary nodules. Conclusion The feasibility of using magnetic beads to locate small pulmonary nodules has been preliminarily verified.
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Objective:To investigate the feasibility of magnetic anchor technique for endoscopic submucosal dissection (ESD) in the treatment of early esophageal cancer.Methods:A self-designed magnetic anchoring device (including an anchor magnet and a target magnet) was used to perform ESD on the hypothesized esophageal lesion mucosa of six isolated esophagus of Beagle dogs. The feasibility and convenience of the operation was evaluated.Results:ESD of 6 isolated esophagus of dogs was successfully completed. Through adjusting the position of anchor magnet, the pulling direction and force of the target magnet on the mucosa could be flexibly controlled, the mucosal peeling surface was fully exposed, and tissue tension was provided to ensure the smooth removal of the diseased mucosa. The entire operation was smooth, and the target magnet was conveniently retained. No target magnet slippage or mucosal laceration occurred during the operation.Conclusion:The magnetic anchor technique is safe and feasible for the ESD, effectively pulling the diseased mucosa in treatment of early esophageal cancer, which can greatly improve the endoscopic operation experience.
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Xi'an Jiaotong University Health Science Center introduces the concept of CDIO (conceive, design, implement and operate) into the training practice of medicine-engineering interdisciplinary talents. By optimizing the curriculum and graduate training mechanism, building academic exchanges and innovative experimental platforms, and guiding students to carry out scientific research oriented to clinical problems, Xi'an Jiaotong University Health Science Center uses medical and industrial methods to solve clinical problems and produce medical achievements. The application of the CDIO model is conducive to deepening students' understanding of interdisciplinary knowledge, forming a fused innovative thinking, and improving the ability to solve problems and cooperate with others. The CDIO model is also conducive to the growth of high-level composite innovative talents, clinical technology innovation, team construction and discipline development, which provides new ideas for exploring the training of medical and engineering interdisciplinary talents.
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@#Objective To verify the feasibility of a self-designed magnetic anchoring and traction device (MATD) for assisting two-port video-assisted thoracoscopic esophagectomy. Methods Three Beagle dogs were selected as animal models with age ranging from 1-6 years and weight ranging from 8-12 kg, and they underwent two-port video-assisted thoracoscopic esophagectomy after general anesthesia. We used the MATD to retract the esophagus to different directions, which assisted mobilizing esophagus, detecting the nerves along esophagus and dissecting paraesophagus lymph nodes. The operation time, blood loss and feasibility of the MATD were recorded. Results With the aid of the MATD, we successfully retracted and mobilized the esophagus, detected the nerves and dissected the lymph nodes in three Beagle dog models. During the operation, the MATD provided sufficient and steady traction of esophagus to achieve a good exposure of the operative field, effectively decreasing the interference between working instruments. The MATD worked well. The mean operation time was 30 min, and the mean intraoperative blood loss was about 10 mL. Conclusion It is effective to use the MATD to assist retracting esophagus during video-assisted thoracoscopic esophagectomy. The magnetic anchoring and traction technique can assist to expose the surgical field, decrease the interference between the working instruments and have the potential clinical application.
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Based on the principle of magnetic anastomosis technique, the design of magnetic anastomosis system for endoscopic tissue clamping is proposed. The system includes a semi-ring magnet, a special structure transparent cap and a detachable push rod. With the help of the existing digestive endoscopy and endoscopic tissue gripper, the endoscopic close clamping and anastomosis of the bleeding or perforated tissue can be completed. After the anastomosis, the magnet falls off and is discharged through the digestive tract. Animal experiments showed that the system was easy to use, the fistula was clamped firmly, the magnet was discharged for 7~21 days, and there was no magnet retention and digestive tract obstruction. Further safety verification, optimization of endoscopic operation, the system can be used in clinical trial.
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Animals , Anastomosis, Surgical , Constriction , Endoscopy, Gastrointestinal , Magnetics , MagnetsABSTRACT
With the development of CT and the popularization of health examination, the detection rate of small pulmonary nodules has been improved. Some small pulmonary nodules could be malignant nodules. Surgical resection is the preferred treatment. Therefore, it is an important task for thoracic surgeons to accurately locate pulmonary nodules during surgery and remove nodules accurately on the premise of maximum protection of lung function. At present, the core of preoperative auxiliary localization of pulmonary nodules is the implantation of markers. The commonly used clinical localization methods include hook wire localization, microcoil localization, methylene blue puncture injection localization and biological glue localization. In this paper, the development status, application scope, advantages and disadvantages of existing localization methods are briefly reviewed, which can provide references for clinical application and follow-up research.
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Objective:To verify the feasibility of a self-designed laparoscopic magnetic anchoring device for assisting thoracoscopic wedge resection.Methods:Six healthy Beagle dogs were selected as animal models, and underwent thoracoscopic wedge resection after general anesthesia. We replaced the pulmonary forceps with a magnetic anchoring device to complete the traction exposure of the lobes, and recorded the operation time of the operation, the amount of intraoperative blood loss, and the safety and feasibility of the magnetic anchoring device.Results:Six Beagle dogs successfully completed a thoracoscopic wedge resection with the aid of a magnetic anchoring device. During the operation, the magnetic anchoring device can completely replaced the exposure function of the pulmonary forceps, effectively eliminating the " chopstick effect" between the instruments during the uniportal video-assisted thoracoscopic operation. The magnetic anchoring device provided sufficient traction for the surgery to achieve a clear exposure of the field. Tissue damage and magnetic anchoring pliers slip did not occur during the operation. The operation time was(22.67±3.25)min(range 18-26 min), and the intraoperative blood loss was less than 10 ml. The experimental animals survived well after surgery.Conclusion:Magnetic anchoring device is safe and effective for thoracoscopic wedge resection, which can eliminate mutual interference between operating instruments and has potential for clinical application.
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Objective:To study the feasibility of establishing gastrointestinal anastomosis by magnetic compression technique in rabbits.Methods:Ten healthy New Zealand rabbits were selected as models for gastrointestinal anastomosis by magnetic compression technique. Daughter and parent magnets suitable for gastrointestinal anastomosis in rabbits were designed and manufactured. A daughter magnet was inserted into the stomach through the purse fistula in the lack of blood vessel area of gastric body, and was pushed into the duodenum along the intestinal tract. And then a parent magnet was inserted through the stomach fistula. The daughter and parent magnets were automatically attracted and pressed the gastric and intestinal walls after they were adjusted in the proper position. The stomach fistula was closed with purse string suture. After ischemia, necrosis, detachment of the tissues between magnets, gastrointestinal anastomosis was established, and the magnets and necrotic tissues were expelled together from the body through the digestive tract. Survival of experimental animals was observed. Anastomotic specimens were obtained one month after operation. The blasting pressure of anastomotic stoma was measured, and the healing of anastomotic stoma was observed with naked eyes.Results:According to the pre-designed operative route, 10 New Zealand rabbits all successfully completed the operation and survived one month after surgery. No complications occurred during perioperative period. The operation time was 35.80±4.71 min (range 28.00-43.00 min), and the magnet discharge time was 11.40±1.56 days (range 9.00-14.00 days). Anastomotic specimens were obtained one month after the operation. Gross observation showed that the anastomotic stoma of gastrointestinal bypass anastomosis healed well, and the surrounding tissues adhered slightly. The anastomotic bursting pressure was 103.00±7.95 mmHg (range 94.00-113.00 mmHg) (1 mmHg=0.133 kPa).Conclusion:The establishment of gastrointestinal anastomosis by magnetic compression technique in rabbits is simple and effective.
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Objective:To design magnets to locate colorectal neoplasms based on magnetic tracer technology, and to test its feasibility and safety by animal experiments.Methods:The magnets used for endoscopic localization of colorectal tumors consist of a tracer magnet and a pursuit magnet, both of which are ring-shaped Nd-Fe-B magnets. Eight healthy Beagle dogs were used as animal models. Tumor locations were assumed in the different parts of the colon and rectum under colonoscopy. The tracer magnet was sent to the hypothetical tumors by endoscopic soft tissue clamp and fixed near the tumors. After 24 hours, laparoscopic surgery was performed under general anesthesia. The pursuit magnet was inserted near the resected colon or rectum through the main operating hole. The tracer magnet was absorbed to the pursuit magnet to identify the location of tumors.Results:The tracer magnet and pursuit magnet were successfully designed and processed. The suction force between the tracer magnet and the pursuit magnet at zero distance was 16 N. All the 8 Beagle dogs successfully received indwelling of magnets under colonoscopy, and no magnets fell off after 24 hours. After the placement of pursuit magnet under laparoscopy, the two magnets attracted each other rapidly and accurately, and successfully completed localization of tumor site without any damage during the operation.Conclusion:Colonoscopy combined with laparoscopy for colorectal neoplasms localization based on magnetic tracer technique is simple, accurate, safe and feasible.
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Objective To verify the feasibility and safety of stomach tumor marker localization based on magnetic tracer technique in dogs.Methods Six male Beagle dogs were examined by gastroscopy.Then tracer magnets were sent to the "tumor" locations assumed in advance and fixed near the "tumors" by endoscopic soft tissue clamp.Laparoscopic gastric tumor localization was performed under general anesthesia 24 hours later.The tracer magnet was placed near the tumor on the surface of the stomach through the operating hole after the conventional establishment of laparoscope puncture parallel mirror to explore the tracer magnet.After the two magnets were attracted,the location of the tracer magnet seen under the laparoscope was the location of the gastric tumor,so as to complete the labeling and positioning of the lesion.Results All the 6 Beagle dogs were successfully implanted with tracer magnets under gastroscopy.Twenty-four hours after the gastroscopy,the pursuit magnet was successfully implanted during laparoscopic surgery.The two magnets automatically attracted each other and formed a sandwich structure of "tracer magnet-gastric wall-pursuit magnet ",which completed the location and identification of gastric tumor under the laparoscopy.Conclusion Gastroscopy combined with laparoscopy based on magnetic tracer technique is simple,accurate,safe and feasible.
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Laparoscopic surgery based on magnetic anchor technique has great potential for further minimally invasive surgery and good surgical field exposure, in which the internal grasper is the key factor. In this paper, an internal grasper based on magnetic anchor laparoscopic surgery is designed, which consists of three parts:target magnet, connection module and tissue forceps. The magnetic shield shell is used to wrap the magnetic core in the target magnet, which not only can increase the magnetic force in the working area, but also reduce the magnetic interference between the instruments, and the connecting module can flexibly adjust the length of the internal grasper. The special structure of tissue gripper can effectively reduce deputy injury and facilitate the replacement of clamp position. It has many advantages, such as ingenious design, easy processing, simple operation and wide range of application, which greatly increased its clinical application value.
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Equipment Design , Laparoscopy , Magnetics , Magnets , Surgical InstrumentsABSTRACT
It is intractable to Complex biliary stricture therapy after liver transplantation and other biliary operations is intractable.The routine therapies are to place stents with ERCP or do choledochojejunostomy.The former,however,is of little effect for patients with complex biliary stricture or completed obstruction.And the latter is more difficult and is with high rate postoperative complications due to the previous operation history.The application of magnetic compression offers a new direction of minimally invasive therapy of complex biliary structure.This article summarizes the current situation of the therapy of complex biliary structure with magnetic compression and the existing obstacles.
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Objective@#To evaluate the feasibility and safety of magnetic tracer technique for preoperative endoscopic marking in laparoscopic surgery.@*Methods@#In the preliminary study, a total of 8 patients with gastric (n=3) or colorectal (n=5) tumors underwent endoscopic magnetic marking before laparoscopic surgery from April to June in 2019. First, a magnet was attached to the lesion by 2 titanium clips under the endoscope. Second, during the subsequent laparoscopic operations, the other magnet was sent to the vicinity of the lesion through the laparoscopic tunnel. The magnet in the abdominal cavity was quickly attracted to the one in the gastrointestinal tract to successfully locate the lesions. Data of preoperative marking and operations of 8 patients were reviewed.@*Results@#All 8 lesions were marked successfully, rapid and accurate intraoperative positioning was achieved. The mean time of endoscopic marking was 5.75±2.45 minutes, and the mean time of intraoperative localization was 1.94±0.56 minutes. All patients underwent laparoscopic tumor resections with accurate localization. The mean proximal and distal resection margins of colorectal tumors were 105 mm and 74 mm respectively. No complications occurred.@*Conclusion@#Magnetic tracer technique for laparoscopic localization, simple, safe and accurate for gastrointestinal lesions, can be performed without additional equipment or endoscopic procedures involved.
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Objective To evaluate the prognostic value of pathological characteristics of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods 289 consecutive HCC patients who underwent curative hepatectomy at Nanjing Drum Tower Hospital from January 2007 to December 2015 were retrospectively studied.These patients were divided into three groups:the no-MVI group (n =176),the low-MVI group (the number of invaded microvessels ≤ 5 and the distance of invasion ≤ 1 cm,n =53) and the high-MVI group (the number of invaded microvessels ＞ 5 or the distance of invasion ＞ 1 cm,n =60).The clinical and pathological data and the survival outcomes of these HCC patients were analyzed.We further compared the prognosis among the three groups.Results Kaplan-Meier survival indicated that the number of invaded microvessels ＞ 5 and the distance of invasion ＞ 1 cm were associated with cumulative and recurrence-free survival rates of HCC patients.The cumulative and recurrence-free survival rates of the high-MVI group were significantly poorer than those of the low-MVI and the no-MVI groups.Multivariate analysis showed ICG-R15 (HR =1.049,95％ CI:1.002 ～ 1.097),tumor size (HR =1.138,95％ CI:1.043 ～ 1.241),and high-MVI (HR =3.245,95％ CI:1.946 ～ 5.413) were independent risk factors for cumulative survival.Tumor size (HR =1.117,95％ CI:1.050 ～ 1.188),and high-MVI (HR =2.222,95％ CI:1.540 ～ 3.205) were independent risk factors for recurrence-free survival.The prognosis of the no-MVI and low-MVI groups were significantly better than the high-MVI group (P ＜ 0.05).The recurrence rates of the low-MVI and no-MVI groups (49.4％ and 67.9％) were significantly lower than the high-MVI group (80.0％,P ＜ 0.05).Conclusions The risk classification of MVI based on histopathological features was valuable in predicting prognosis of HCC patients.We could use the risk classification of MVI to establish a follow-up and individualized treatment plan for HCC patients.
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Objective To investigate the value of perfusion imaging in predicting the status of isocitrate dehydrogenase 1 (IDH1) in glioblastoma.Methods Retrospectively studied 30 patients with glioblastoma multiforme with wild type IDH1 (IDHw) and 30 patients with mutant IDH1 (IDH1m) in Department of Neurosurgery,Shanxi Provincial People's Hospital from September 2014 to February 2016.Ktrans and Ve within the enhancing portion of each tumor were measured by using DCE-MRI data.rCBF and rCBV within the enhancing portion of each tumor were measured by using DSC-MRI.Four parameters were represented as (x) ± s,each of the 4 parameters was compared between patients with wild type IDH1 and mutant IDH1 by using the t-test.The performance in discriminating between the two entities was evaluated by using receiver operating characteristic analysis.Results Ktrans,Ve,rCBF and rCBV inside the enhancing lesion were significantly higher in patients with wild type IDH1 than in those with mutant IDH1.There was a statistically significant difference between IDH1w group and IDH1m group of rCBF value (P ＜ 0.05).The area under the curve for Ktrans,Ve,rCBF,and rCBV inside the enhancing lesion were 0.850,0.873,0.739 and 0.772,respectively.The value of rCBF value of the Ktrans value Ve value of IDH1w was significantly higher than that of IDH1m(P ＜0.05) in the value of the Ktrans value Ve value of rCBF,the value of the AUC value in rCBV was not significantly different with the combination of the 4 parameters of the diagnostic performance (AUC =0.915).Conclusions Ktrans,Ve,rCBF and rCBV calculated from MRI are useful for predicting the IDH1 mutation status.This method is not only for the classification of brain glioblastoma diagnosis has important value,and in glioblastoma classification is of important value in the preoperative noninvasive evaluation,and it has reference significance for predicting the prognosis of patients.
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Magnetic anchor technique can reduce the number of trocar in laparoscopic surgery. The laparoscopic magnetic anchor system consists of an external anchor magnet and the magnetic clutch system. Electromagnetic control laparoscopic surgery clutch system includes the internal grasper and the operating forceps. In this design, a permanent magnet is set at the tail of the internal grasper, and an electromagnetic device is installed at the head of the operating forceps. The magnetic field direction of the electromagnetic device can be changed by switching the positive pole and the negative pole of the electromagnetic device, so as to control the separation and combination of the operating forceps and the internal grasper. The design of this system is ingenious, easy to manufacture and the operation is simple.
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Electromagnetic Phenomena , Equipment Design , Laparoscopy , Magnetics , Surgical InstrumentsABSTRACT
Objective To study the safety and efficacy of magnetic compression anastomosis (MCA) in treatment of biliary anastomotic stricture after orthotopic liver transplantation (LT).Methods Five patients who were treated unsuccessfully by ERCP were admitted to The First Affiliated Hospital of Xi'an Jiaotong University from 2012 January to 2018 May to undergo MCA.The treatment results were analyzed retrospectively.Results In four patients,the treatment was successful while in one patient it failed.For the four successful patients,the biliary stricture length was 2～4 mm.Re-canalization was achieved within 7～12 days and these patients were discharged home without any adverse events.Multiple plastic stents (in 2 patients) or full-covered self-expansion mental stents (in 2 patients) were inserted into the new fistulae after re-canalization.In two patients whose stents were removed,there was no recurrence of biliary strictures after follow-up for 64 months and 59 months,respectively.Conclusion The MCA technique is a revolutionary and effective method of performing interventional choledochocholedochostomy in patients with biliary anastomotic stricture after LT for whom the conventional endoscopic procedures were not successful.
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Objective To investigate the predictive values of preoperative radiological features-intratumoral arteries and tumoral morphological classification on microvascular invasion (MVI) and on prognosis in patients with hepatocellular carcinoma (HCC).Methods A total of 220 consecutive HCC patients who underwent curative hepatectomy at Nanjing Drum Tower Hospital from January 2008 to December 2014 were retrospectively analyzed.The predictive values of preoperative radiological features and clinical data on MVI were analyzed by the univariate analysis and multivariate logistic regression methods.The prognosis of HCC patients was analyzed by the Kaplan-Meier survival analysis and the Cox proportional hazards models.Results Univariate analysis and multivariate logistic regression showed intratumoral arteries and tumoral morphological classification using preoperative CT[called the radiological predictorsof microvascular invasion (RPMVI)] to be independent predictors of MVI.The AUROC for RPMVI inpredicting MVI was O.830 (95％ CI,O.769 ～ 0.891,P ＜0.05).The Cox multivariate analysis identified Child-Pugh grading,tumor size ＞ 5 cm,RPMVI,MVI and non-anatomical liver resection to be independent risk factorsof overall survival (OS),while tumor size ＞ 5 cm,RPMVI,MVI and non-anatomical liver resection to be independent risk factor sofre currence-free survival (RFS).The 1-,3-,and 5-year OS rates were 83.3％,61.7％,and 40.1％ in patients with RPMVI and 97.1％,76.5％,and 69.6％ in patients without RPMVI (P ＜0.05),respectively.The 1-,3-,and 5-year RFS rates were 61.9％,36.9％,and 28.4％ in patients with RPMVI and 81.6％,61.9％,and 52.2％ in patients without RPMVI (P ＜ 0.05),respectively.Conclusions RPMVI is a novel radiological marker that accurately predicted histological MVI in HCC patients preoperatively.Similar to MVI,RPMVI was found to be an independent risk factor for prognosisin HCC patients,and it may provide the important information for surgical treatment planning in HCC patients.