A New Technique for Liver Retraction During Single-Port Laparoscopic Surgery

Abstract

Establishing a clear operative viewing field and adequate working space are essential steps for safe laparoscopic surgery. This aim of this article is to report a new technique of liver retraction during upper gastrointestinal laparoscopic surgery. This technique is fast and simple and precludes the use of special devices. It avoids the use of a subxiphoid trocar exclusive for liver retraction. This technique was designed to be used in single-port laparoscopic surgery but can be used in standard laparoscopic surgery to reduce the number of trocars. The first step is to perform division of the left triangular ligament. The fibrous appendix is identified. A window in the falciform ligament is created. The fibrous appendix is sutured to the peritoneum in the right subcostal area. The left lobe of the liver passes through the window in the falciform ligament, avoiding liver congestion. Optimum exposure of the upper gastrointestinal area is achieved. This new technique is easy and can be performed in various types of laparoscopic gastrointestinal surgeries without the need for specific skills or devices. We believe that our liver retraction technique is useful in single-port laparoscopic surgery and allows an excellent exposure of the upper gastrointestinal tract.

A Simple Method of Intracorporeal “W-shaped” Liver Retraction Technique for Minimally Invasive Gastric Cancer Surgery

“…To avoid the additional skin incision or puncture site, Huang et al 4 used a penrose drain and laparoscopic stapler to create a V-shaped liver suspension technique for laparoscopic bariatric surgery and further randomized controlled trial demonstrated the rise of liver enzyme at 18 hours after operation was less significantly when compared with Nathanson liver retractor group. 3 Besides, some internal liver retraction methods can be accomplished by using EndoLift (Virtual Ports Inc., Caesarea, Israel) 7 and n-Butyl-2-cyanoacrylate (NBCA) glue to bond the left lateral lobe of the liver to the diaphragm. 12 Although these novel internal retraction methods are easy to use, additional commercial instruments and cost is required for exposure and lymph node dissection and seems to be inadequate during gastric cancer surgery.…”

“…The conventional mechanical retractors such as the Nathanson retractors or snake retractors required a subxiphoid skin incision and an additional trocar, which increased postoperative pain and complications, such as elevation of liver function tests and risk of iatrogenic liver injury. 2,3 Various techniques were introduced to reduce the additional incision or liver damage such as using skin needle puncture, protective materials, [4][5][6][7][8][9][10] and commercially designed totally intracorporeal liver retraction. 11,12 Here, we present the W-LRT in laparoscopic or robotic gastric cancer surgery, which is simple, safe, secure technique, and avoids an additional skin incision or puncture.…”

Liver retraction using n-butyl-2-cyanoacrylate glue during laparoscopic cholecystectomy

“…In clinical settings, it is essential to establish a clear surgical field and generate adequate working space for safe laparoscopic surgery. [ 1 ] To our best knowledge, attenuating the “protrusion” of the quadrate lobe of liver is crucial for adequate working space and generation of a clear surgical field. In the past decades, electrocoagulation hook of the right hand had been commonly utilized to block the “protrusion” of the quadrate lobe of liver.…”

Intra-abdominal Trocar-Free Vacuum Liver Retractor for Upper-Gastrointestinal Surgery

“…These aspects are of major importance especially in single-port laparoscopic surgery, also reducing the number of ports needed. 10 Apart from the internal devices, liver retraction methods using stitches fixing the liver to the abdominal wall were also used. 4 The variety of available internal organ retraction systems demonstrates the lack of adequate solutions in this field.…”