Role of magnetic anchors during laparoendoscopic single site surgery and NOTES

Evolution of minimally invasive techniques has generated an impetus in the surgical community to reduce the invasiveness of laparoscopic surgery. To achieve this goal, surgeons are either limiting the number of transabdominal trocars using laparoendoscopic single site surgery (LESS) or eliminating them completely using natural orifice translumenal endoscopic surgery (NOTES). The principle challenge with LESS or NOTES procedures is loss of triangulation, reduction in instrument working envelopes, and collision of conventional laparoscopic instrumentation. To overcome these limitations, surgical innovations, such as the use of deployable intracorporeal instrumentations, are necessary. Magnetic anchoring and guidance system (MAGS) technology is one approach for deployable instrumentation whereby intra-abdominal instruments can be maneuvered by the use of an external handheld magnet. Such a strategy would permit a single access port (either transabdominal or via a natural orifice) to serve as an entry point for multiple instruments. MAGS technology has thus far developed to incorporate instruments such as retractors, an intra-abdominal camera, and cautery dissectors. Continuous instrument development and rapid prototyping have created more robust MAGS platforms while potentially obviating the need for laparoscopic assistance. Animal work to date is promising with successful completion of a single-port nephrectomy as well as a NOTES transvaginal cholecystectomy in both nonsurvival and survival porcine models. As with all new technology, there will be an associated learning curve for these MAGS techniques that will necessitate more thorough elucidation before widespread use. The development of magnetically controlled and anchored intracorporeal surgical instruments, retractors, and cameras may advance surgical practice and improve patient care while meeting or exceeding the benefits of current-day fixed-trocar laparoscopy.