In order to simplify a percutaneous gastrostomy procedure and avoid the need of endoscopy or imaging methods, a novel percutaneous magnetically guided gastrostomy (PMG) technique was conceived. The aim of the present study is to evaluate the feasibility of a novel PMG technique with no endoscopy or any imaging guidance in a porcine model.
Fourteen crossbred domestic pigs were used for prototype development (cadaveric experiments) and proof-of concept, survival study. The magnetic device was conceived using commercially available rare-earth neodymium-based magnets. The experimental design consisted of developing an internal magnetic gastric tube prototype to be orally inserted and coupled to an external magnet placed on the skin, which facilitated stomach and abdominal wall apposition for blind percutaneous gastrostomy tube placement. Then, a gastrostomy tube was percutaneously and blindly placed.
Twelve procedures were undertaken in animal cadavers and two in live models. The technique chosen consisted of using a magnetic gastric tube prototype using six 1 × 1-cm-ring magnets attached to its end. This device enabled successful magnetic coupling with a large (5 cm in diameter) magnet disc placed on the skin. For gastric tube placement, a direct trocar insertion allowed easier and safer placement of a gastric tube as compared to a needle-guide-wire dilation (Seldinger-based) technique. Gastropexy was added to avoid early gastric tube displacement. This novel PMG technique was feasible in a live model experiment.
A novel magnetically guided percutaneous gastrostomy tube insertion technique without the use of endoscopy or image-guidance was successful in a porcine model. A non-inferiority experimental controlled study comparing this technique to percutaneous endoscopic gastrostomy is needed to confirm its efficacy and safety.
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The authors would like to thank the contributions made by SENAI-RS team, represented by Rodrigo Kalikoski; Biosupply team: Edison Martins da Silva Junior, Ivan Miranda, Marcelo Saraiva, and Diki Schertel; Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS, Brazil: Drs. Fernando Herz Wolff, MD, PhD and Richard Ricachenevsky Gurski MD, PhD; Universidade Positivo, Curitiba, Brazil: Cirlei da Silva Pereira, Vanderlei Muller, Taise Fuchs, Flávia Marinoni Plois, and Marjory Priscilla Valente; Mrs. Marcia Olandoski, for statistical analysis; and Mrs. Suzana Gontijo, for English language review.
This project obtained the Grant Edital SENAI/SESI de inovação 2013, Number 88564, Porto Alegre, RS, Brazil.
The authors Eduardo Aimore Bonin, Paulo Roberto Walter Ferreira, Marcelo de Paula Loureiro, Thais Costa-Casagrande, Paolo de Oliveira Salvalaggio, and Leandro Totti Cavazzola have a patent pending on the device used in the present study. Dr. Christopher John Gostout is a co-founder and Chief Medical Officer at Apollo Endosurgery, Inc, TX, USA. Drs. Guilherme Francisco Gomes and Rafael William Noda have no conflicts of interest or financial ties to disclose.
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Bonin, E.A., Ferreira, P.R.W., de Paula Loureiro, M. et al. A novel percutaneous magnetically guided gastrostomy technique without endoscopy or imaging guidance: a feasibility study in a porcine model. Surg Endosc 32, 4688–4697 (2018). https://doi.org/10.1007/s00464-018-6335-5
- Percutaneous endoscopic gastrostomy
- Surgical technique
- Surgical device