A new anastomat for digestive tract operations, based on the magnetic compressive technique and mechanical transmission mechanism, is composed of a removable head and a reusable body. The head includes two parts: the proximal end can be fixed to the body, and the distal end could be used for performing a purse string suture. The procedure of anastomosis is similar to that of the stapler, and the anastomoses is established using a pair of magnetic rings. The instrument makes magnamosis more simple and feasible, and it would facilitate the clinical application. The body of the anastomat is reusable and the head could be replaced according to the clinical scenarios, these could reduce the medical cost. The magnetic rings would be excreted with the feces, and there is no foreign body response at last.
Anastomosis, Surgical ; instrumentation ; methods ; Gastrointestinal Tract ; surgery ; Humans ; Magnetics

The quality of a donor liver after cardiac death is closely associated with energy metabolism during preservation. Ex vivo mechanical perfusion has broad application prospects because this technique can help energy metabolism and repair ischemia injury of donors' livers. Some core issues are presented in this review in order to provide references for propelling secure application of liver transplantation based on donation after cardiac death.
Death ; Humans ; Liver ; Liver Transplantation ; Organ Preservation ; methods ; Perfusion ; methods ; Warm Ischemia ; adverse effects

AIM: To explore the effect of hydrogen sulfide on the senescence of human umbilical vein endothe -lial cells (HUVECs) induced by high glucose.METHODS: Senescence model was established by treating HUVECs with33 mmol/L glucose for 48 h.The parameters were detected to demonstrate the effect of hydrogen sulfide on senescence andthe mechanism involved was also investigated .RESULTS: In the cells treated with high glucose, the proliferation was attenuatedwith a higher number of senescence -associated β-galactosidase (SA-β-Gal) positive cells, and plasminogen activatorinhibitor 1 (PAI-1) protein expression, malondialdehyde (MDA) production and NF-κB p65 activity were increasedsignificantly, but the expression of superoxide dismutase 1 (SOD1) was decreased.However, the cell number and SOD1expression were increased, and the number of SA-β-Gal positive cells, PAI-1 protein expression, MDA production and theactivity of NF-κB p65 were decreased after sodium hydrosulfide (100 and 200 μmol/L) treatment.CONCLUSION: Exogenoushydrogen sulfide prevents HUVECs against high glucose -induced senescence by suppressing oxidative stress and NF -κB p65 activity.

OBJECTIVETo evaluate the feasibility of endoscopic gastrostomy combined with magnetic compression techniques in dogs.

METHODSThe magnetic compression device consisted of a couple of cylindrical magnets with a hole in the center. A 14-French gastric tube was inserted through the hole and fixed on the parent magnets. Four male mongrel dogs were selected randomly for the operation. The daughter magnet was placed into the dog's gastric body by a Zebra Guidewire under endoscopy, then a skin incision was performed on the left upper abdomen, through which the subcutaneous tissues and muscle were isolated up to the peritoneum. The parent magnet was placed on the surface of the peritoneum, which attracted the daughter magnet inside the gastric cavity automatically to compress the gastric wall and peritoneum. A needle was inserted through the gastric tube and punctured the tissue in the hole of the magnets repeatedly to form a fistula. After removing the needle, the gastrostomy was complete. The fistula was observed and its specimen was taken two weeks later under laparotomy.

RESULTSAll the four operations were successfully performed, and the operation time was 11-15 minutes. The stoma was matured immediately, through which early enteral nutrition support was administered. The gastric wall and peritoneum were observed with well healing and no adhesion in the abdominal cavity under laparotomy two weeks after the operation.

CONCLUSIONThe gastrostomy performed by magnetic compression technique combined with endoscopy is convenient, minimally invasive and safe, which may be used in future clinical practice.

Abdomen ; Animals ; Catheterization ; Dogs ; Enteral Nutrition ; Gastroscopy ; Gastrostomy ; Laparotomy ; Magnetics ; Male ; Santonin ; analogs & derivatives ; Stomach ; Surgical Stomas ; Wound Healing

Objective To develop a pulling device using magnetic positioning to optimize the procedures of repairment of donor liver from organ donation . Methods The pig liver specimens were used to measure the pull force of repairment of donor liver, magnetic spiderman was developed based on the measurement results. The magnetic spiderman was applied to simulate the repairment of donor liver from organ donation on the pig liver specimens. The effectiveness of magnetic spiderman was also evaluated. Results The pulling force was required all less than 2 N during the repairment of donor liver. The magnetic spiderman was successfully manufactured. The magnets of magnetic spiderman could generate 3 N magnetic forces with paramagnetic basin of hepatic repairment. The self-retraction pull wire of the magnetic spiderman could provide 2.5 N pulling forces. The magnetic spiderman was successfully applied to the simulated experiment of repairment of donor liver from organ donation in 6 cases. The operation time was (54±5) min. No clip slippage,displacement and slippage of the base occurred during the operation. With the cooperation of multiple magnetic spidermen,the remaining surgical procedures were performed by one single surgeon except for the vascular ligation. Conclusions The magnetic spiderman has small volume and implements flexible positioning, can perform pulling operation and nottake up operational space. It can effectively optimize the procedures of repairment of donor liver from organ donation and reduce the quantity of surgeons.

Objective To evaluate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP)-based comprehensive minimally invasive treatment for biliary anastomotic stenosis (BAS) after liver transplantation. Methods Clinical data of 60 BAS recipients after liver transplantation were retrospectively analyzed, 54 male and 6 female, aged (48±10) years. ERCP was initially carried out. If it succeeded, plastic or metallic stents were placed into the biliary tract. If it failed, percutaneous transhepatic cholangial drainage (PTCD) or single-operator cholangioscopy (SpyGlass) was adopted to pass through the stenosis. If all these procedures failed, magnetic anastomosis or other special methods were delivered. The incidence and treatment of BAS after liver transplantation were summarized. The efficacy, stent removal and recurrence were observed. Results The median time of incidence of BAS after liver transplantation was 8 (4, 13) months. Within postoperative 1 year, 1-2 years and over 2 years, 39, 16 and 5 recipients were diagnosed with BAS, respectively. All 60 BAS recipients after liver transplantation were successfully treated, including 56 cases initially receiving ERCP, and 41 completing BAS treatment, with a success rate of 73%. The failure of guide wire was the main cause of ERCP failure. The success rates of PTCD, SpyGlass and magnetic anastomosis were 5/9, 5/7 and 7/8, respectively. Two recipients were successfully treated by percutaneous choledochoscope-assisted blunt guide wire technique and stent placement in the biliary and duodenal fistula. After 3 (3, 4) cycles of ERCP and 13 (8, 18) months of stent indwelling, 38 recipients reached the stent removal criteria, including 25 plastic stents and 13 metallic stents. The indwelling time of plastic stents was longer than that of metallic stents (P < 0.05). Six cases suffered from stenosis recurrence at 12 (8, 33) months after stent removal, and the recurrence rate was 16%. Six patients were treated with ERCP, and 5 of them did not recur after the stents were successfully removed. Multivariate analysis showed that delayed diagnosis of stenosis and frequent ERCP before stent removal were the independent risk factors for BAS recurrence (both P < 0.05). Conclusions ERCP-based comprehensive minimally invasive treatment may improve the success rate of BAS treatment after liver transplantation and yield satisfactory long-term efficacy. Delayed diagnosis of BAS and high frequent ERCP required for stent removal are the independent risk factors for BAS recurrence.