A Novel Technique for Liver Retraction in Laparoscopic Bariatric Surgery

Abstract

During bariatric surgery in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction--V-shaped liver suspension technique (V-LIST)--by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009-February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2-18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.

The “T-Suspension Tape” for Liver and Gallbladder Retraction in Bariatric Surgery: Feasibility, Technique, and Initial Experience

“…[1][2][3][4][5] However, there are only a few reports on such liver retraction techniques for bariatric procedures. We had previously described and published the early results of the V-lift technique 6 and also the liver suspension tape in single-incision laparoscopic bariatric surgery. 7,8 Over the course of time we made modifications to the liver suspension technique to develop the ''T-suspension tape'' (TST) and found it valuable for retracting the liver as well as the gallbladder in various bariatric procedures, including multiport and single-incision laparoscopic surgery.…”

Scarless Bariatric Surgery

“…[ Figures 1-3] [13]. Another non-puncturing method with a penrose drain and endo-hernia stapler has also been reported by us [18]. These techniques have been proved to be a quick and safe method in SILS bariatric surgery.…”

Novel Trocarless, Scarless Technique for Left Lobe Liver Retraction in Laparoscopic Upper Gastrointestinal Surgeries: Simple, Cost-effective and with Better Cosmesis

“…After surgeons switched over to advanced laparoscopic work and SILS in the region of upper gastrointestinal tract, there are many different techniques described in the literature for left lobe liver retraction, namely Nathanson liver retractor, blunt rod, fan retractor, Istanbul technique [2], liver suspension device, V-LIST technique [3], triangle method [4] and so on. Conventional techniques like Nathanson, blunt rod and fan retractor mandate to insert a 5-mm port at least, while other techniques like triangle method and V-LIST were using a laparoscopic stapler or specialised energy sources, which used to increase the cost of surgery.…”