Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

Abstract

Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

Keywords: Endoscopic submucosal dissection; Esophageal cancer; Gastric cancer; Magnetic anchor guidance; Magnets; Natural orifice transluminal endoscopic surgery; Traction.

Figure 1

Endoscopic submucosal dissection with and without retraction. Endoscopic submucosal dissection (ESD) without retraction on the left demonstrates the mucosa impeding the visual field. ESD with retraction using the clip-line method on the right allows for better visualization of the surgical field with the mucosa pulled away.

Figure 2

Magnetic anchor system using neodymium permanent magnet. ESD: Endoscopic submucosal dissection.