A SAFE AND VERSATILE APPROACH TO CREATE MAGNETIC COMPRESSION BOWEL ANASTOMOSES UTILIZING MAGNAMOSIS

Thank you. Um, first, thank you all for your time and for your support over the years with this technology. My name is Michelle Patel. I'm a general surgery resident here at the University of Washington, currently in Doctor Harrison's lab at the, uh, University of California, San Francisco. Um, no disclosures. Sorry, yeah, thanks, um, yeah, uh, very briefly, first we'll start with the magnomosis, uh, device, some of the engineering considerations, it's something that a lot of you in the audience have probably already seen before, um, then I'll go briefly, thank you, into our multiple human successes, um, which is the crux of this talk and very quickly touch upon our future directions here. So first, it starts with magnemosis. These are our 23 millimeter magnetic rings encased in polycarbonate and biologically inert. Um, these rings will self-align due to the magnetic polarity and end up creating a functional anastomosis within about 4 to 5 days. The key here is the actual shape of the magnet of the casing. Where at the center there's a significant significant amount of pressure which actually causes tissue necrosis at the periphery, it exponentially drops off, actually creating a pretty good milieu for scar tissue and healing. Um, so far we've been successful in 8 humans, um, and many pigs and monkeys. So just quickly, uh, we've successfully done this um for gastrogenostomies for small bowel, small bowel anastomosis, and colonic anastomoses. Um, when we actually look at the burst pressure for these, um, the new anastomoses are as strong as hand suture and significantly stronger than staples, so we know it works and incredibly these anastomoses have not yet leaked. So this was our first human trial where we were successfully put it in 5 patients who are receiving ileal conduits, um, where a small portion of the ileum is hooked up to the to the ureters and then drains into the ileum. Um, with this conduit, these patients open surgery and we place these magnets and it's very quick, within 25 to 35 minutes of just that open portion of the procedure. And once we're able to get these magnets in there, they created this functional anastomosis and um your urine drained appropriately. Uh, these magnets do pass through the colon and are excreted normally, and these patients did have neurogenic bowel, but they passed within about 17 to 54 days. So it's not our ideal patient population, but still a pretty good human success. And this is just some of the post-op imaging. So initially you can see in the right lower quadrant these magnets are there, they're pretty well aligned and located appropriately. In about 2 weeks they did migrate down to the rectum. Um, and of course these were an open surgery. Our goal here is to try and make it an endoscopic approach, um, and this was one patient we had at UCSF who was 58 years old, uh, child C cirrhosis with a small bowel obstruction. Um, not an operative candidate, and using endoscopy we were able to place both magnets in the small bowel, and they ended up aligning well enough, passing through and creating a functional conduit where the bowel obstruction was relieved and the patient would go home. So this is our endoscopic floral approach, um, and you could see these magnets initially in post-op day zero. Going back and taking a look at him, he did have an ileostomy, so this is a fairly quick ileoscopy. Um, the magnets at base 7 basically demonstrate pretty good healthy tissue with central villi and healing, and then at day 30 it created a functional anastomosis which we haven't had an issue with yet to this day. Um, so what uses do we have? I mean, currently we're using it for these ileal conduits, um, ileostomy takedowns, and some palliative procedures, including gastrogenostomies. We're trying to branch off into metabolic and bariatric surgery, but I think one of the things, at least for this audience, was Doctor Harrison conceived this as a solution for oesophageal atresia. Um, and while there's devices out there, we're continuing to address that and try and handle oesophageal strictures and. Um, esophageal atresia using a magnetic system. So thank you for your time and open to any questions.