Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass

Abstract

The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique. Both V-LIST and liver suspension tape have a short learning curve and implications for single-port surgery.

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

“…We have already published a randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass, wherein we demonstrated a significant rise in levels of aspartate aminotransferase and alanine aminotransferase while using fixed retractors compared with liver puncture technique using the liver suspension tape. 16 Another unique feature of the TST is that it can be used to retract the right and left lobes of the liver, the gallbladder, and even the falciform ligament either in isolation or in combination. Moreover, the Teflon tape evenly distributes the pressure and reduces the risk of cuttingthrough.…”

Liver Retraction by Double-Sling Suture for Laparoscopic Gastrectomy

“…Postoperative liver dysfunction with the DSS method is comparable to or less than that of the LP technique or other previously reported methods. 3,6,20,23 Third, the surgeon can obtain an optimal operative view because there is no bulky protective material, such as gauze, in the area. Because the sling suture runs parallel to the liver surface, no acute angle is encountered between the contact point on the liver surface and the suture material.…”

“…5,6,8 Thus, the time required for the entire procedure is approximately 3 minutes, which is shorter than the time for the LP technique or other methods reported in the literature. 2,7,20,23 Second, it is less likely to damage the liver because it does not hamper the hepatic blood supply by mechanical compression. In contrast to previous techniques, 15 no repositioning of the retraction is needed, and the surgeon can focus on the operation without being concerned with the possibility of hepatic necrosis.…”

“…Moreover, they can cause iatrogenic liver injury. 3,13,23 The LP method, which was adapted from our previous laparoscopic gastrectomy report, is an acceptable alternative. 4 It reduces the number of ports and provides a good operative view.…”

Systematic Review of Retraction Devices for Laparoscopic Surgery

“…A significant but nonpermanent derangement in liver function was detected after using the Nathanson's instrument, 11 as determined by an increase in aspartate aminotransferase and alanine aminotransferase. This was attributed to the shape of the instrument.…”