Magnet-Assisted Hydraulic Bougienage for Correction of Long-Gap Esophageal Atresia.

Abstract

An infant born with long-gap esophageal atresia has its esophagus separated into two pouches, and typically undergoes multiple open-chest surgeries for esophageal reconstruction. In this paper, we study a possible approach for less invasive correction of long-gap esophageal atresia. Our technique utilizes a magnet-tipped catheter with a piston on the end to push the esophageal pouch from the inside. The attractive magnetic force helps the catheter stretch the esophageal pouches, while the hydraulic piston prevents the magnet from applying too large force. The piston also enables estimation of the esophageal tension based on the hydraulic pressure measurement. We have built a prototype system and performed bench-level tests on an esophageal mock-up. A hydraulic dither is applied to the piston to average out seal friction, thereby improving the tension estimation performance. The bench-level tests demonstrate that the prototype bougienage system gives a reliable low-frequency estimate of the esophageal tension in real-time, and also enables longitudinal bougienage by a desired amount of load, e.g., 2N, for various gap sizes. This study provides a foundation for the next step of designing a system for use on actual patients.