Editorial Comment on: “Magnetic-Assisted Robotic and Laparoscopic Renal Surgery: Initial Clinical Experience with the Levita Magnetic Surgical System” by Fulla et al.

Magnetic devices represent one of many efforts to further minimize the invasiveness of surgery in the modern era, whereas potentially maximizing efficiency. In this article, Fulla et al. report a case series comprising 10 patients undergoing laparoscopic and robotic renal surgery, in which Levita™ was used for retraction. ¹ This pilot study demonstrated that usage of this magnetic device was feasible and safe if used correctly. The concept of magnetic devices is not new among surgeons—it has been introduced in various aspects of surgery such as sterile magnetic fields, retraction, anchoring, mobilization, and anastomosis especially in gastrointestinal surgeries.

In the desire to expand application of single port (SP) surgery, the magnetic device may see increasing popularity as we move forward to adopt the SP surgery (laparoendoscopic single-site surgery or Da Vinci SP). For example, in Da Vinci SP system, the surgeon can control three instruments and one endoscope. If such a magnetic device is used, the assistant port can be spared, and retraction optimized from different angles.

One should be cautious as this study is nonrandomized and included only select patients. Obese patient with large abdominal wall thickness would fail this device as it decreases the coupling force. Patients with pacemaker or implantable cardioverter-defibrillator in place should be excluded. As stainless steel is one of the most commonly used metal alloys in the manufacture of surgical implements, the magnetic controller could turn the surgical instruments into magnetic if stored improperly. The benefit of fewer trocar sites should be weighed against the aforementioned risks. Future studies should be directed to understand the safety profile and to examine if there are any additional benefits such as decreased operative time and improved patient satisfaction.