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Eur J Pediatr Surg 2025; 35(04): 316-321
DOI: 10.1055/a-2507-8135
Original Article

Feasibility and Challenges of Pyeloureteral Magnetic Anastomosis Device in Domestic Pigs: A Stepwise Approach with Extended Observation

Rainer Kubiak
1   Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, Sankt Gallen, Switzerland
,
Zita Hornok
2   Department of Pediatric Surgery, Hungarian Reformed Church Bethesda Children's Hospital, Budapest, Hungary
,
Domokos Csukas
3   Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
,
Andrea Ferencz
3   Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
,
Tamas Cserni
4   Department of Pediatric Urology, Manchester Children's Hospitals, Manchester, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Fundings This study was supported by a grant from the Kidneys For Life Charity, Manchester (Charity number 505256).
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Abstract

Objective The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral magnetic anastomosis device (PUMA) was proven in minipigs, but only in short term. Our aim was to test the PUMA in domestic pigs and achieve a prolonged follow-up period.

Methods Five female domestic pigs underwent laparoscopy and ligation of the left ureter. Four weeks later, laparoscopic implantation of the PUMA was planned. Removal of the device and a retrograde contrast study were scheduled after another 4 weeks. The experiment was terminated when the animals could no longer be properly cared for due to their weight.

Results Due to unexpected smaller ureteric diameters, a modified PUMA could only be successfully inserted in pig number 3 (49 kg). Four weeks later, the device was found to be dislocated, but the anastomosis remained patent. After modifying the study protocol, the PUMA was successfully implanted in pigs number 4 (96 kg) and 5 (68 kg) 8 weeks after ureteric ligation. Pig 4 developed malignant hyperthermia and died. In pig 5, the magnets were removed 4 weeks later. After an additional 8 weeks, the animal reached 135 kg and was terminated. The anastomosis remained patent and preserved its diameter.

Conclusion Despite limitations, our study successfully demonstrated that the PUMA can achieve a patent ureteric anastomosis in domestic pigs. This suggests a potential for minimally invasive ureteric anastomosis in clinical settings. Further research is needed to optimize the technique and validate its effectiveness in humans.

Keywords

laparoscopy - magnamosis - surgical innovation - PUMA device - pyeloplasty

Authors' Contribution

R.K. collected the data (animal laboratory), participated in data analysis and interpretation, and wrote the manuscript. Z.H. participated in data collection (animal laboratory) and data analysis. D.C. participated in data collection (animal laboratory) and data analysis. A.F. participated in data collection (animal laboratory) and data analysis. T.C. designed the study, collected the data (animal laboratory), and participated in data analysis and interpretation. All authors have approved the final manuscript.




Publication History

Received: 30 May 2024

Accepted: 22 December 2024

Article published online:
20 January 2025

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