Closure of the gastric incision with magnets at the end of the transgastric NOTES interventions

Szülőkategória: KUTATÁSI TÉMÁK
10. 01. 09
Módosítás: 01 december 2016

Kecskédi Bence 1, Lukovich Péter dr. 2, Gerő Dániel 1, Tari Krisztina 2, Váradi Gábor dr. 2, Jónás Attila dr. 2, Kupcsulik Péter dr. 2

Magyar Gasztroenterológiai Társaság 50. Nagygyűlése, Tihany, 2008. június 6-11.


(1) Semmelweis University, Faculty of Medicine , (2) 1 st Department of Surgery, Semmelweis University Budapest, Hungary

Absztrakt: Z Gastroenterol.


Introduction: Nowdays the difficulty of the treatment called NOTES is to close the gastric or colonic incision. This is the reason why the first clinical application of NOTES, cholecystectomy, was performed through the transvaginal route, where secure closure is actually the most feasible.

Method: We used two tubes, which were rigged at the two sides of a traditional flexible endoscope, containing two rectangular rare-earth magnets (20*1*5 mm). We used two metal guidewires to push down these magnets, and, if needed, to positionate them adequately. During the retraction of the endoscope through the working channel, we folded the gastric wall around the incision with a grasper. Magnets were then pushed out of the tubes to both sides of the fold, thus shutting the gastrotomic entry site. Former human experimental studies report that magnetic pressure necrotises the tissues and causes a sterile inflammation in the penumbra. Magnets would leave patients body per vias naturales.

Results: We performed our experiment on slaughtered porcine's isolated gastro-intestinal tract, using a standardized incision (diameter: 15mm). Most closures were successful, once the magnets lost contact, two times the closure was insufficient. The succesfully closed gastrotomic holes were leak-proof and resisted to a 10 Hgmm pressure. Procedures took approximately 3-4 minutes, we repeated them 20 times.

Conclusion: Our method's advantages are its rapidity and simplicity. We plan to realise the experiment in vivo, design a new endoscope-compatible device and make further investigations to find out the optimal size of the magnets.