Recommendations and best practices in the field of magnetic surgery (2024)

Monitoring Editor: Qiang Shi

Magnetic surgery is defined as surgical treatment by utilization of magnetic technology, including magnetic devices and carriers. Magnetic techniques include compression, navigation, levitation, anchoring, and delivery.^[1] Interest in magnetic surgery has increased over the past decade due to its potential to facilitate minimally invasive procedures. Thus guidelines for the use of magnetic technology in surgery need to be established.

Magnetic devices can be classified according to duration of use: as permanently implanted, intra-operative, and temporarily implanted.

Magnet use cases:

• (1)

  Permanently Implanted Magnetic Devices

  Permanently implanted magnetic devices are magnets that are meant to remain in the body for the life of the patient. Examples include magnetic sphincter augmentation for gastroesophageal reflux disease and magnetic hyoid suspension for sleep apnea.^[2]

• (2)

  Intra-operatively Used Magnetic Devices

  Intra-operatively used implantable magnets are often utilized in magnetic anchoring and magnetic navigation techniques, and are meant to be removed at the end of the procedure.

• (3)

  Temporarily Implanted Magnetic Devices

  Temporarily implanted magnetic devices are often utilized in magnetic compression anastomoses of hollow viscera such as digestive tract, as well as in vascular anastomoses.^[3] They are meant to work over a period of time after the surgical procedure end.

General guidelines for implantable magnetic devices:

• (1)

  Materials: To guarantee adequate force, the powerful neodymium iron boron is commonly used. Its grades include N35, N40, N42, N45, N48. A permanent magnet can also be paired with magnetizable materials, or an external electromagnet to generate magnetic force.

• (2)

  Surface coatings and layers: Special coatings are necessary for intra-corporeal magnets to ensure biocompatibility and to prevent leaking of toxic components into tissue. These coatings can include polycarbonate, gold, parylene, and more in multiple layers for redundancy. For short-term implanted magnets, titanium nitride coating is recommended; while for permanent implanted magnets, titanium alloy sealing by laser is recommended.

• (3)

  Appropriate sterilization methods should be used which do not cause corrosion and degradation of magnetic properties. Corrosive and high temperature sterilization methods are not recommended for magnets. Ethylene oxide sterilization, low temperature cold plasma techniques, and gamma radiation sterilization are generally effective for magnet sterilization while preserving magnetic characteristics.

• (4)

  Awareness of inadvertent magnetic force should be maintained, and caution must be exercised when placing multiple pairs of magnets as they may attract and exert magnetic force in unexpected locations. In addition, caution should be exercised with use of electrocautery or ferromagnetic surgical instruments in a patient with magnetic devices.

As with all medical research, patient safety must be paramount during the experimental development and use of magnetic medical technology.

Task force member affiliations (sorted alphabetically by last name):

Vamsi Aribindi, University of California, San Francisco, United States; Emanuele Asti, University of Milan, Italy; Ji-Gang Bai, The First Affiliated Hospital of Xi’an Jiaotong University, China; Ping Bie, Southwest Hospital, Army Medical University, China; Luigi Bonavina, University of Milan, Istituto di Ricovero e Cura a Carattere Scientifico Policlin San Donato, Italy; Jeffrey Cadeddu, University of Texas Southwestern Medical Center, United States; Truman Cheng, Chinese University of Hong Kong, China; Catherine Co, University of Santo Tomas, Philippines; Boris Dolgushin, Blokhin Russian Oncology Research Center, Russia; Jia-Hong Dong, Beijing Tsinghua Changgung Hospital, China; Mark Bremholm Ellebæk, Odense University Hospital, Denmark; Hai-Ming Fan, Northwest University, China; Chi-Hua Fang, Zhujiang Hospital, Southern Medical University, China; Jun-Ke Fu, The First Affiliated Hospital of Xi’an Jiaotong University, China; Xing-Jie Gao, Stereotaxis, Inc. United States; Ning Gu, Southeast University, China; Ya-Yi Hou, Nanjing University, China; Bing Hu, West China Hospital, Sichuan University, China; Hideaki Kawabata, Kyoto Okamoto Memorial Hospital, Japan; Dongki Lee, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea; Jian-Hui Li, Shaanxi Provincial People's Hospital, China; Yu Li, The First Affiliated Hospital of Xi’an Jiaotong University, China; Zheng Li, Chinese University of Hong Kong, China; Zhuan Liao, Changhai Hospital, Second Military Medical University, China; Shi-Qi Liu, Xi’an Children's Hospital, China; Xue-Min Liu, The First Affiliated Hospital of Xi’an Jiaotong University, China; Yun Lu, The Affiliated Hospital of Qingdao University, China; Tian-Yu Ma, Xi’an Jiaotong University, China; Ke-Wei Meng, Tianjin First Center Hospital, China; Avaliani Mikheil, Blokhin Russian Oncology Research Center, Russia; Padraig Cantillon Murphy, University College Cork, Ireland; Erkan Parlak, Sakarya University, Turkey; Boris Polyak, Drexel University, United States; Peng Shang, Northwestern Polytechnical University, China; Bao-Gen Shen, Institute of Physics, Chinese Academy of Sciences, China; Yuan Shi, Tianjin First Center Hospital, China; Hao Sun, The First Affiliated Hospital of Xi’an Jiaotong University, China; Yi-Feng Sun, Shanghai Chest Hospital, China; Xiao-Jiang Tang, The First Affiliated Hospital of Xi’an Jiaotong University, China; Ibrahim Uygun, Dicle University, Turkey; Michel Vaena, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Qiu-Liang Wang, Institute of Electrical Engineering, Chinese Academy of Sciences, China; Rong-Qian Wu, The First Affiliated Hospital of Xi’an Jiaotong University, China; Zheng Wu, The First Affiliated Hospital of Xi’an Jiaotong University, China; Xiao-Peng Yan, The First Affiliated Hospital of Xi’an Jiaotong University, China; Shi-Wen Yuan, Lund University Hospital, Sweden; Vitalii Zablotskii, Institute of Physics of the Academy of Sciences of the Czech Republic, Czech; Mario F. Zaritzky, University of Chicago, United States; Xin Zhang, High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, China; Xu-Feng Zhang, The First Affiliated Hospital of Xi’an Jiaotong University, China; Yong Zhang, The First Affiliated Hospital of Xi’an Jiaotong University, China; Yu-Liang Zou, The First Affiliated Hospital of Xi’an Jiaotong University, China.

Conflicts of interest

None.

Footnotes

References