Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

Abstract

BACKGROUND:The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them.MATERIAL AND METHODS:A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.CONCLUSIONS:The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

Short-term and Long-term Outcomes Following Laparoscopic Gastrectomy for Advanced Gastric Cancer Compared With Open Gastrectomy

“…25 We use a Penrose drain for liver retraction, which is gentle and less likely to cause liver dysfunction compared with other retractors. 26 Liver enzyme elevation was seen on postoperative days 1 to 4, and the level gradually returned to normal (Figs. 1, 2).…”

Stability and Retraction Force Verification of a New Retractor Design for Minimally Invasive Surgery

“…Internal tissue damage is also reduced by not grasping or puncturing the liver for retraction. The three bands would create a larger surface area when compared to the Versa Lifter Band [11] that only uses one band or other retraction solutions that use strings [14] for retracting the liver. The only internal tissue damage is caused on the right crus of the diaphragm if the first proposed string/band solution is applied.…”

Hepatic retractor in an ex vivo model

“…The most used methods were: NG suspension (36 cases), umbilical tape (22 cases) and hepatic suspension by puncture and drain use (22 cases). It is not possible to compare these methods with what was used in ex vivo pig liver 2 .…”