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Optimization of tracheoesophageal fistula model established with Tshaped magnet system based on magnetic compression technique

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World Journal of Gastroenterology 2024年第16期30卷 2272-2280页

作者： Miao-Miao Zhang Jian-Qi Mao Lin-Xin Shen Ai-Hua Shi Xin Lyu Jia Ma Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Shaanxi Provincial Key Laboratory of magnetic Medicine The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Zonglian College Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Department of Pulmonary and Critical Care Medicine The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710004Shaanxi ProvinceChina Department of Surgical Oncology Shaanxi Provincial People’s HospitalXi’an 710068Shaanxi ProvinceChina

BACKGROUND The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula(TEF),but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control.We designed a Tshaped magnet system to overcome these problems and verified its effectiveness via animal experiments.AIM To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs.METHODS Twelve beagles were randomly assigned to groups in which magnets of the Tshaped scheme(study group,n=6)or normal magnets(control group,n=6)were implanted into the trachea and esophagus separately under gastroscopy.Operation time,operation success rate,and accidental injury were recorded.After operation,the presence and timing of cough and the time of magnet shedding were observed.Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing,and gross specimens of TEFs were obtained.Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery,and gross specimens were obtained.Fistula size was measured in all animals,and then harvested fistula specimens were examined by hematoxylin and eosin(HE)and Masson trichrome staining.RESULTS The operation success rate was 100%for both groups.Operation time did not differ between the study group(5.25 min±1.29 min)and the control group(4.75 min±1.70 min;P=0.331).No bleeding,perforation,or unplanned magnet attraction occurred in any animal during the operation.In the early postoperative period,all dogs ate freely and were generally in good condition.Dogs in the control group had severe cough after drinking water at 6-9 d after surgery.X-ray indicated that the magnets had entered the stomach,and gastroscopy showed TEF formation.Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm±1.29 mm(range,3.52-6.56 mm).HE and Masson trichrome staining showed scar tissue formation and hierarchical structural

关键词： magnetic surgery magnetic compression technique Tracheoesophageal fistula Magnet Animal model Beagles

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Treatment of anastomotic stricture after rectal cancer operation by magnetic compression technique:A case report

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World Journal of Gastrointestinal surgery 2024年第5期16卷 1443-1448页

作者： Miao-Miao Zhang Huan-Chen Sha Hai-Rong Xue Yuan-Fa Qin Fang-Fang Dong Li Zhang Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Shaanxi Provincial Key Laboratory of magnetic Medicine The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUNDThe treatment of postoperative anastomotic stenosis(AS)after resection of colorectalcancer is challenging.Endoscopic balloon dilation is used to treat stenosisin such cases,but some patients do not show improvement even after multipleballoon dilations.magnetic compression technique(MCT)has been used for gastrointestinalanastomosis,but its use for the treatment of postoperative AS aftercolorectal cancer surgery has rarely been reported.CASE SUMMARYWe report a 72-year-old man who underwent radical resection of colorectal cancerand ileostomy one year ago.An ileostomy closure was prepared six months ago,but colonoscopy revealed a narrowing of the rectal anastomosis.Endoscopic balloondilation was performed three times,but colonoscopy showed no significantimprovement in stenosis.The AS was successfully treated using MCT.CONCLUSIONMCT is a minimally invasive method that can be used for the treatment of postoperativeAS after colorectal cancer surgery.

关键词： Rectostenosis magnetic surgery magnetic surgery Clinic Rectal cancer magnetic compression technique Case report

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magnetic-assisted laparoscopic liver transplantation in swine

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 340-346页

作者： Zhe Feng Shan-Pei Wang Hao-Hua Wang Qiang Lu Wei Qiao Kai-Ling Wang Hong-Fan Ding Yue Wang Rong-Feng Wang Ai-Hua Shi Bing-Yi Ren Yu-Nan Jiang Bin He Jia-Wei Yu Rong-Qian Wu Yi Lv Department of Hepatobiliary surgery the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine Shaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringInstitute of Advanced Surgical Technology and Engineeringthe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China Department of Geriatric surgery the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China Department of Hepatobiliary surgery Shaanxi Provincial People’s HospitalXi’an 710000China Zonglian College Xi’an Jiaotong UniversityXi’an 710000China

Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular anastomosis.In this study,we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs.Methods:Two sets of magnetic vascular anastomosis rings(MVARs)with different diameters were developed.One set was used for anastomosis of the suprahepatic vena cava(SHVC)and the other set was used for anastomosis of the infrahepatic vena cava(IHVC)and portal vein(PV).Six laparoscopic orthotopic liver transplantations were performed in pigs.Donor liver was obtained via open surgery.Hepatectomy was performed in the recipients through laparoscopic surgery.Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis,and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance.Results:Liver transplants were successfully performed in five of the six cases.Postoperative ultrasonographic examination showed that the portal inflow was smooth.However,PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other.The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13±5 vs.5±1 min(Pmagnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.

关键词： Liver transplantation Laparoscopy magnetic surgery Vascular anastomosis

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magnetic compression anastomosis for reconstruction of digestive tract after total gastrectomy in beagle model

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World Journal of Gastrointestinal surgery 2023年第7期15卷 1294-1303页

作者： Miao-Miao Zhang Chen-Guang Li Shu-Qin Xu Jian-Qi Mao Yu-Han Zhang Ai-Hua Shi Yan Li Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Department of Critical Care Medicine China-Japan Union Hospital of Jilin UniversityChangchun 130000Jilin ProvinceChina Zonglian College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Qide College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina

BACKGROUND magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,Pmagnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.

关键词： magnetic surgery magnetic compression anastomosis Gastric cancer Total gastrectomy Roux-en-Y esophagojejunal anastomosis Beagles

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Primary animal experiment to test the feasibility of a novel Y-Z magnetic hepatic portal blocking band

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World Journal of Gastrointestinal surgery 2023年第7期15卷 1286-1293页

作者： Miao-Miao Zhang Chen-Guang Li Shu-Qin Xu Jian-Qi Mao Yu-Xiang Ren Yu-Han Zhang Jia Ma Ai-Hua Shi Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Department of Critical Care Medicine China-Japan Union Hospital of Jilin UniversityChangchun 130000Jilin ProvinceChina Zonglian College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Qide College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Department of Surgical Oncology Shaanxi Provincial People's HospitalXi'an 710068Shaanxi ProvinceChina

BACKGROUND Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy.We designed a novel Y-Z magnetic hepatic portal blocking band(Y-Z MHPBB)based on the principle of magnetic compression technique.AIM To introduce the Y-Z MHPBB device and verify the feasibility of this device for hepatic portal blood flow occlusion in dogs.METHODS Ten beagles were randomly divided into the experimental group and control group.The operation time,intraoperative blood loss,the number of portal blood flow occlusions,the total time spent on adjusting the blocking band,and the average time spent on adjusting the blocking band were recorded.The surgeons evaluated the feasibility and flexibility of the two portal occlusion devices.RESULTS Laparoscopic hepatectomy was successfully performed in both the experimental group and control group.There was no statistical difference between the two groups in the operation time,intraoperative blood loss,and the number of hepatic portal blood flow occlusions.With respect to the total time spent on adjusting the blocking band and the average time spent on adjusting the blocking band,the experimental group showed significantly better outcomes than the control group,with a statistical difference(P<0.05).The operators found that the Y-Z MHPBB was superior to the modified T-tube in terms of operational flexibility.CONCLUSION The Y-Z MHPBB seems to be an ingenious design,accurate blood flow occlusion effect,and good flexibility;and it can be used for hepatic portal blood flow occlusion during laparoscopic hepatectomy.

关键词： Hepatic portal blood flow occlusion Laparoscopic hepatectomy Novel Y-Z magnetic hepatic portal blocking band magnetic surgery magnetic compression technique Beagles

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Novel deformable self-assembled magnetic anastomosis ring for endoscopic treatment of colonic stenosis via natural orifice

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世界胃肠病学杂志:英文版 2023年第33期29卷 5005-5013页

作者： Miao-Miao Zhang Guang-Bin Zhao Han-Zhi Zhang Shu-Qin Xu Ai-Hua Shi Jian-Qi Mao Jing-Ci Gai Yu-Han Zhang Jia Ma Yun Li Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina State Key Laboratory for Manufacturing System Engineering School of Mechanical EngineeringXi'an Jiaotong UniversityXi'an 710054Shaanxi ProvinceChina College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Zonglian College Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Department of Surgical Oncology Shaanxi Provincial People's HospitalXi'an 710068Shaanxi ProvinceChina

BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.

关键词： magnetic surgery Magnamosis Colonic stenosis Natural orifice Endoscopy

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magnetic anchor technique assisted endoscopic submucosal dissection for early esophageal cancer

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World Journal of Gastrointestinal Endoscopy 2023年第10期15卷 584-592页

作者： Min Pan Miao-Miao Zhang Shu-Qin Xu Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Department of Thoracic surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal cancer has gradually been realized.Endoscopic submucosal dissection(ESD)has become the standard of care for managing early tumors of the esophagus,stomach,and colon.However,due to the steep learning curve,difficult operation,and technically demanding nature of the procedure,ESD has currently been committed to the development of various assistive technologies.AIM To explore the feasibility and applicability of magnetic anchor technique(MAT)-assisted ESD for early esophageal cancer.METHODS Isolated pig esophagi were used as the experimental model,and the magnetic anchor device was designed by us.The esophagi used were divided into two groups,namely the operational and control groups,and 10 endoscopists completed the procedure.The two groups were evaluated for the following aspects:The total operative time,perforation rate,rate of whole mucosal resection,diameter of the peering mucosa,and scores of endoscopists’feelings with the procedure,including the convenience,mucosal surface exposure degree,and tissue tension.In addition,in the operational group,the soft tissue clip and the target magnet(TM)were connected by a thin wire through a small hole at the tail end of the TM.Under gastroscopic guidance,the soft tissue clip was clamped to the edge of the lesioned mucosa,which was marked in advance.By changing the position of the anchor magnet(AM)outside the esophagus,the pulling force and pulling direction of the TM could be changed,thus exposing the mucosal peeling surface and assisting the ESD.RESULTS Herein,each of the two groups comprised 10 isolated esophageal putative mucosal lesions.The diameter of the peering mucosa did not significantly differ between the two groups(2.13±0.06 vs 2.15±0.06,P=0.882).The total operative time was shorter in the operational group than in the control group(17.04±0.22 min

关键词： magnetic surgery magnetic anchor technique magnetic anchor device Endoscopic submucosal dissection Early esophageal cancer

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Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer

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World Journal of Gastrointestinal Endoscopy 2023年第11期15卷 658-665页

作者： Min Pan Miao-Miao Zhang Lin Zhao Yi Lyu Xiao-Peng Yan Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Department of Thoracic surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine The First Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Zonglian College Xi’an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina

BACKGROUND Gastric cancer(GC)has high morbidity and mortality.Moreover,because GC has no typical symptoms in the early stages,most cases are already in the advanced stages by the time the symptoms appear,thus resulting in poor prognosis and a low survival rate.Endoscopic submucosal dissection(ESD)can realize the early detection and diagnosis of GC and become the main surgical method for early GC.However,ESD has a steep learning curve and high technical skill requirements for endoscopists,which is not conducive to its widespread implementation and advancement.Therefore,a series of auxiliary techniques have been derived.AIM To evaluate the safety and efficacy of magnetic anchor technique(MAT)-assisted ESD in early GC.METHODS This was an ex vivo animal experiment.The experimental models were the isolated stomachs of pigs,which were divided into two groups,namely the study group(n=6)with MAT-assisted ESD and the control group(n=6)with traditional ESD.Comparing the total surgical time,incidence of surgical complications,complete mucosal resection rate,specimen size,and the scores of endoscopist’s satisfaction with the procedure reflected their feelings about convenience during the surgical procedure between the two groups.The magnetic anchor device for auxiliary ESD in the study group comprised three parts,an anchor magnet(AM),a target magnet(TM),and a soft tissue clip.Under gastroscopic guidance,the soft tissue clip and the TM were delivered to the pre-marked mucosal lesion through the gastroscopic operating hole.The soft tissue clip and the TM were connected by a thin wire through the TM tail structure.The soft tissue clip was released by manipulating the operating handle of the soft tissue clip in a way that the soft tissue clip and the TM were fixed to the lesion mucosa.In vitro,ESD is aided by maneuvering the AM such that the mucosal dissection surface is exposed.RESULTS The total surgical time was shorter in the study group than in the control group(26.57±0.19 vs 29.97±0.28,P<0.001),and the scores of endoscopist

关键词： Endoscopic submucosal dissection Gastric cancer Digestive disease magnetic anchor technique magnetic surgery magnetic anchor device

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